Detailed Abstract
[Poster Presentation 5 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[PP 5-1] EARLY RECURRENCE PREDICTORS AND PATTERNS AFTER RESECTION FOR PANCREATIC DUCTAL ADENOCARCINOMA: IS THE SURGEON ONLY A BYSTANDER?
Alex M. ROCH 1, Alexa HUGHES 1, Kyra N. FOLKERT 1, Ryan J. ELLIS 1, Thomas K. MAATMAN 1, C.Max SCHMIDT 1, Nicholas J. ZYROMSKI 1, Eugene P. CEPPA 1, Michael G. HOUSE 1
1 Surgical Oncology, Indiana University School of Medicine, USA
Background : Surgical resection is the primary curative option for pancreatic ductal adenocarcinoma (PDAC); however, high recurrence rates persist despite surgical advancements. Early recurrence (ER), within 12 months post-surgery, poses a unique and poorly understood challenge. This study aims to identify ER risk factors and recommend tailored surveillance for high-risk patients.
Methods : Patients undergoing curative pancreatic resection for PDAC at our center (2015-2020) were analyzed using logistic regression to assess ER predictors and impacts on overall survival (OS).
Results : Among 348 patients over a median 1.9-year follow-up, 76.7% experienced recurrence, with 40.2% encountering ER. Independent risk factors for ER included higher-grade tumors (p=0.008,OR 2.8), positive lymph nodes (p=0.01,OR 1.4), elevated initial CA19-9 (>37 U/mL) (p=0.014,OR 3.5), low serum albumin(p=0.007,OR=4.1), and the absence of adjuvant chemotherapy(p=0.037,OR=7.5). CDKNA1/2 mutations raised ER risk significantly(p=0.01), while BRCA1/2 mutations were protective(p=0.016). Resection margins and postoperative pancreatic fistula did not increase ER risk (p=0.4, p=0.23). Liver was the most common site of ER (32.9%). A small subset had ER with lung metastasis only (7.9%), linked to extended post-recurrence survival (2.2 vs. 0.48 years, p=0.001). ER correlated with poorer OS: 49.3%, 7.9%, and 4.3% at 1-, 3-, and 5-years compared to 100%, 44.9%, and 10.2% for late recurrence (p=0.001, p=0.001, p=0.048).
Conclusions : ER arises from aggressive tumor biology. Surgical outcomes like margins and complications/postoperative pancreatic fistula have minimal impact on ER. The use of adjuvant chemotherapy and BRCA-mutated PDAC lessen the ER risk. ER to the lungs was associated with the best prognosis. Understanding risk factors and recurrence patterns guides personalized management.
Methods : Patients undergoing curative pancreatic resection for PDAC at our center (2015-2020) were analyzed using logistic regression to assess ER predictors and impacts on overall survival (OS).
Results : Among 348 patients over a median 1.9-year follow-up, 76.7% experienced recurrence, with 40.2% encountering ER. Independent risk factors for ER included higher-grade tumors (p=0.008,OR 2.8), positive lymph nodes (p=0.01,OR 1.4), elevated initial CA19-9 (>37 U/mL) (p=0.014,OR 3.5), low serum albumin(p=0.007,OR=4.1), and the absence of adjuvant chemotherapy(p=0.037,OR=7.5). CDKNA1/2 mutations raised ER risk significantly(p=0.01), while BRCA1/2 mutations were protective(p=0.016). Resection margins and postoperative pancreatic fistula did not increase ER risk (p=0.4, p=0.23). Liver was the most common site of ER (32.9%). A small subset had ER with lung metastasis only (7.9%), linked to extended post-recurrence survival (2.2 vs. 0.48 years, p=0.001). ER correlated with poorer OS: 49.3%, 7.9%, and 4.3% at 1-, 3-, and 5-years compared to 100%, 44.9%, and 10.2% for late recurrence (p=0.001, p=0.001, p=0.048).
Conclusions : ER arises from aggressive tumor biology. Surgical outcomes like margins and complications/postoperative pancreatic fistula have minimal impact on ER. The use of adjuvant chemotherapy and BRCA-mutated PDAC lessen the ER risk. ER to the lungs was associated with the best prognosis. Understanding risk factors and recurrence patterns guides personalized management.
SESSION
Poster Presentation 5
Exhibition Hall 3/27/2025 2:50 PM - 3:30 PM