Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2024; 16(10): 3185-3201
Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3185
Recurrence scoring system predicting early recurrence for patients with pancreatic ductal adenocarcinoma undergoing pancreatectomy and portomesenteric vein resection
Hang He, Cai-Feng Zou, Yong-Jian Jiang, Feng Yang, Yang Di, Ji Li, Chen Jin, De-Liang Fu
Hang He, Cai-Feng Zou, Yong-Jian Jiang, Feng Yang, Yang Di, Ji Li, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
Co-first authors: Hang He and Cai-Feng Zou.
Author contributions: He H and Zou CF contributed equally to the study; He H concepted and designed the research; Li J, Jin C and Fu DL provided administrative support; Jiang YJ, Yang F and Di Y contributed to follow-up; He H and Zou CF collected and assembled data; He H performed data analysis and wrote the manuscript; All authors read and approved the manuscript.
Supported by National Natural Science Foundation of China, No. 82373012.
Institutional review board statement: This study was reviewed and approved by the Clinical Research Ethics Committee of Huashan Hospital (Approval No. 1037).
Informed consent statement: This study retrospectively included data without any intervention for the patients. The informed consent document is not applicated.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: All data and results of this study were presented in the article and the supplementary file. No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hang He, MD, PhD, Surgeon, Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai 200040, China. hhe10@fudan.edu.cn
Received: May 26, 2024
Revised: August 19, 2024
Accepted: September 9, 2024
Published online: October 27, 2024
Processing time: 125 Days and 1.7 Hours
Abstract
BACKGROUND

Pancreatectomy with concomitant portomesenteric vein resection (PVR) enables patients with portomesenteric vein (PV) involvement to achieve radical resection of pancreatic ductal adenocarcinoma, however, early recurrence (ER) is frequently observed.

AIM

To predict ER and identify patients at high risk of ER for individualized therapy.

METHODS

Totally 238 patients undergoing pancreatectomy and PVR were retrospectively enrolled and were allocated to the training or validating cohort. Univariate Cox and LASSO regression analyses were performed to construct serum recurrence score (SRS) based on 26 serum-derived parameters. Uni- and multivariate Cox regression analyses of SRS and 18 clinicopathological variables were performed to establish a Nomogram. Receiver operating characteristic curve analysis was used to evaluate the predictive accuracy. Survival analysis was performed using Kaplan-Meier method and log-rank test.

RESULTS

Independent serum-derived recurrence-relevant factors of LASSO regression model, including postoperative carbohydrate antigen 19-9, postoperative carcinoembryonic antigen, postoperative carbohydrate antigen 125, preoperative albumin (ALB), preoperative platelet to ALB ratio, and postoperative platelets to lymphocytes ratio, were used to construct SRS [area under the curve (AUC): 0.855, 95%CI: 0.786–0.924]. Independent risk factors of recurrence, including SRS [hazard ratio (HR): 1.688, 95%CI: 1.075-2.652], pain (HR: 1.653, 95%CI: 1.052-2.598), perineural invasion (HR: 2.070, 95%CI: 0.827-5.182), and PV invasion (HR: 1.603, 95%CI: 1.063-2.417), were used to establish the recurrence nomogram (AUC: 0.869, 95%CI: 0.803-0.934). Patients with either SRS > 0.53 or recurrence nomogram score > 4.23 were considered at high risk for ER, and had poor long-term outcomes.

CONCLUSION

The recurrence scoring system unique for pancreatectomy and PVR, will help clinicians in predicting recurrence efficiently and identifying patients at high risk of ER for individualized therapy.

Keywords: Early recurrence; Portomesenteric vein resection; Pancreatic ductal adenocarcinoma; Recurrence score; Nomogram

Core Tip: Portomesenteric vein involvement is common in pancreatic ductal adenocarcinoma, which is correlated to the poor outcome, and needs individualized therapy. Pancreatectomy and portomesenteric vein resection (PVR) allow patients to achieve radical resection, however, early recurrence is frequently observed. This study constructed the first tailored recurrence scoring system unique for patients undergoing pancreatectomy and PVR, which consisted of Serum Recurrence Score and Recurrence Nomogram. With this scoring system, clinicians could predict early recurrence efficiently, and identify patients at high-risk of recurrence for individualized therapy timely, aiming to restrain the recurrence and improve the prognosis.