Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma

Vincent P. Groot, Georgios Gemenetzis, Alex B. Blair, Roberto J. Rivero-Soto, Jun Yu, Ammar A. Javed, Richard Burkhart, Inne H.M.Borel Rinkes, I. Quintus Molenaar, John L Cameron, Matthew J Weiss, Christopher Wolfgang, Jin He

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To establish an evidence-based cut-off to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups. SUMMARY BACKGROUND DATA: A clear definition of "early recurrence" after pancreatic ductal adenocarcinoma resection is currently lacking. METHODS: Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrence were assessed with logistic regression models. RESULTS: Of 957 included patients, 204 (21.3%) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5%) and late recurrence (n = 365, 48.5%) was 12 months (P < 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6% compared with 45 and 22% for the late recurrence group (both P < 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index ≥4 (OR 1.65), tumor size > 3.0 cm on computed tomography (OR 1.53) and CA 19-9 > 210 U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19-9 > 37 U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence. CONCLUSION: A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis.

Original languageEnglish (US)
Pages (from-to)1154-1162
Number of pages9
JournalAnnals of surgery
Volume269
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Adenocarcinoma
Recurrence
Logistic Models
Pancreatectomy
Neoadjuvant Therapy
Survival
Chemoradiotherapy
Adjuvant Chemotherapy
Lymph Nodes
Tomography

ASJC Scopus subject areas

  • Surgery

Cite this

Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma. / Groot, Vincent P.; Gemenetzis, Georgios; Blair, Alex B.; Rivero-Soto, Roberto J.; Yu, Jun; Javed, Ammar A.; Burkhart, Richard; Rinkes, Inne H.M.Borel; Molenaar, I. Quintus; Cameron, John L; Weiss, Matthew J; Wolfgang, Christopher; He, Jin.

In: Annals of surgery, Vol. 269, No. 6, 01.06.2019, p. 1154-1162.

Research output: Contribution to journalArticle

Groot, VP, Gemenetzis, G, Blair, AB, Rivero-Soto, RJ, Yu, J, Javed, AA, Burkhart, R, Rinkes, IHMB, Molenaar, IQ, Cameron, JL, Weiss, MJ, Wolfgang, C & He, J 2019, 'Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma', Annals of surgery, vol. 269, no. 6, pp. 1154-1162. https://doi.org/10.1097/SLA.0000000000002734
Groot, Vincent P. ; Gemenetzis, Georgios ; Blair, Alex B. ; Rivero-Soto, Roberto J. ; Yu, Jun ; Javed, Ammar A. ; Burkhart, Richard ; Rinkes, Inne H.M.Borel ; Molenaar, I. Quintus ; Cameron, John L ; Weiss, Matthew J ; Wolfgang, Christopher ; He, Jin. / Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma. In: Annals of surgery. 2019 ; Vol. 269, No. 6. pp. 1154-1162.
@article{4d4b9f2e309744dea457b7b61d269cef,
title = "Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma",
abstract = "OBJECTIVES: To establish an evidence-based cut-off to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups. SUMMARY BACKGROUND DATA: A clear definition of {"}early recurrence{"} after pancreatic ductal adenocarcinoma resection is currently lacking. METHODS: Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrence were assessed with logistic regression models. RESULTS: Of 957 included patients, 204 (21.3{\%}) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5{\%}) and late recurrence (n = 365, 48.5{\%}) was 12 months (P < 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6{\%} compared with 45 and 22{\%} for the late recurrence group (both P < 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index ≥4 (OR 1.65), tumor size > 3.0 cm on computed tomography (OR 1.53) and CA 19-9 > 210 U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19-9 > 37 U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence. CONCLUSION: A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis.",
author = "Groot, {Vincent P.} and Georgios Gemenetzis and Blair, {Alex B.} and Rivero-Soto, {Roberto J.} and Jun Yu and Javed, {Ammar A.} and Richard Burkhart and Rinkes, {Inne H.M.Borel} and Molenaar, {I. Quintus} and Cameron, {John L} and Weiss, {Matthew J} and Christopher Wolfgang and Jin He",
year = "2019",
month = "6",
day = "1",
doi = "10.1097/SLA.0000000000002734",
language = "English (US)",
volume = "269",
pages = "1154--1162",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma

AU - Groot, Vincent P.

AU - Gemenetzis, Georgios

AU - Blair, Alex B.

AU - Rivero-Soto, Roberto J.

AU - Yu, Jun

AU - Javed, Ammar A.

AU - Burkhart, Richard

AU - Rinkes, Inne H.M.Borel

AU - Molenaar, I. Quintus

AU - Cameron, John L

AU - Weiss, Matthew J

AU - Wolfgang, Christopher

AU - He, Jin

PY - 2019/6/1

Y1 - 2019/6/1

N2 - OBJECTIVES: To establish an evidence-based cut-off to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups. SUMMARY BACKGROUND DATA: A clear definition of "early recurrence" after pancreatic ductal adenocarcinoma resection is currently lacking. METHODS: Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrence were assessed with logistic regression models. RESULTS: Of 957 included patients, 204 (21.3%) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5%) and late recurrence (n = 365, 48.5%) was 12 months (P < 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6% compared with 45 and 22% for the late recurrence group (both P < 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index ≥4 (OR 1.65), tumor size > 3.0 cm on computed tomography (OR 1.53) and CA 19-9 > 210 U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19-9 > 37 U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence. CONCLUSION: A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis.

AB - OBJECTIVES: To establish an evidence-based cut-off to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups. SUMMARY BACKGROUND DATA: A clear definition of "early recurrence" after pancreatic ductal adenocarcinoma resection is currently lacking. METHODS: Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrence were assessed with logistic regression models. RESULTS: Of 957 included patients, 204 (21.3%) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5%) and late recurrence (n = 365, 48.5%) was 12 months (P < 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6% compared with 45 and 22% for the late recurrence group (both P < 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index ≥4 (OR 1.65), tumor size > 3.0 cm on computed tomography (OR 1.53) and CA 19-9 > 210 U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19-9 > 37 U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence. CONCLUSION: A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis.

UR - http://www.scopus.com/inward/record.url?scp=85066061157&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066061157&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000002734

DO - 10.1097/SLA.0000000000002734

M3 - Article

C2 - 31082915

AN - SCOPUS:85066061157

VL - 269

SP - 1154

EP - 1162

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 6

ER -