Prediction of Isolated Local Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Study.

Autor: van Goor IWJM; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands. i.w.j.vangoor-5@umcutrecht.nl.; Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands. i.w.j.vangoor-5@umcutrecht.nl., Andel PCM; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands., Buijs FS; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands., Besselink MG; Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Amsterdam, The Netherlands., Bonsing BA; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Bosscha K; Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands., Busch OR; Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Amsterdam, The Netherlands., Cirkel GA; Department of Medical Oncology, University Medical Center Utrecht Cancer Center & Meander Medical Center Amersfoort, Regional Academic Cancer Center Utrecht, Utrecht University, Utrecht, The Netherlands., van Dam RM; Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands., Festen S; Department of Surgery, OLVG, Amsterdam, The Netherlands., Koerkamp BG; Department of Surgery, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands., van der Harst E; Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands., de Hingh IHJT; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Kazemier G; Cancer Center Amsterdam, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands., Liem MSL; Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands., Meijer G; Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands., de Meijer VE; Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Nieuwenhuijs VB; Department of Surgery, Isala, Zwolle, The Netherlands., Roos D; Department of Surgery, Renier de Graaf Gasthuis, Delft, The Netherlands., Schreinemakers JMJ; Department of Surgery, Amphia Hospital, Breda, The Netherlands., Stommel MWJ; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Wit F; Department of Surgery, Tjongerschans Hospital, Heerenveen, The Netherlands., Verdonk RC; Department of Gastroenterology, Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands., van Santvoort HC; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands., Molenaar IQ; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands., Intven MPW; Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands., Daamen LA; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands. l.a.daamen-3@umcutrecht.nl.; Imaging Division, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands. l.a.daamen-3@umcutrecht.nl.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Nov; Vol. 31 (12), pp. 8264-8275. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1245/s10434-024-15664-4
Abstrakt: Background: Distinguishing postoperative fibrosis from isolated local recurrence (ILR) after resection of pancreatic ductal adenocarcinoma (PDAC) is challenging. A prognostic model that helps to identify patients at risk of ILR can assist clinicians when evaluating patients' postoperative imaging. This nationwide study aimed to develop a clinically applicable prognostic model for ILR after PDAC resection.
Patients and Methods: An observational cohort study was performed, including all patients who underwent PDAC resection in the Netherlands (2014-2019; NCT04605237). On the basis of recurrence location (ILR, systemic, or both), multivariable cause-specific Cox-proportional hazard analysis was conducted to identify predictors for ILR and presented as hazard ratios (HRs) with 95% confidence intervals (CIs). A predictive model was developed using Akaike's Information Criterion, and bootstrapped discrimination and calibration indices were assessed.
Results: Among 1194/1693 patients (71%) with recurrence, 252 patients (21%) developed ILR. Independent predictors for ILR were resectability status (borderline versus resectable, HR 1.42; 95% CI 1.03-1.96; P = 0.03, and locally advanced versus resectable, HR 1.11; 95% CI 0.68-1.82; P = 0.66), tumor location (head versus body/tail, HR 1.50; 95% CI 1.00-2.25; P = 0.05), vascular resection (HR 1.86; 95% CI 1.41-2.45; P < 0.001), perineural invasion (HR 1.47; 95% CI 1.01-2.13; P = 0.02), number of positive lymph nodes (HR 1.04; 95% CI 1.01-1.08; P = 0.02), and resection margin status (R1 < 1 mm versus R0 ≥ 1 mm, HR 1.64; 95% CI 1.25-2.14; P < 0.001). Moderate performance (concordance index 0.66) with adequate calibration (slope 0.99) was achieved.
Conclusions: This nationwide study identified factors predictive of ILR after PDAC resection. Our prognostic model, available through www.pancreascalculator.com , can be utilized to identify patients with a higher a priori risk of developing ILR, providing important information in patient evaluation and prognostication.
(© 2024. The Author(s).)
Databáze: MEDLINE
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