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): 3211-3223
Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3211
Postoperative serum tumor markers-based nomogram predicting early recurrence for patients undergoing radical resections of pancreatic ductal adenocarcinoma
Hang He, Cai-Feng Zou, Feng Yang, Yang Di, Chen Jin, De-Liang Fu
Hang He, Cai-Feng Zou, Feng Yang, Yang Di, 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 concepted and designed the study; Jin C and Fu DL provided administrative support; Yang F and Di Y helped acquire follow-up data; He H and Zou CF assembled data and performed analysis; He H wrote the manuscript. All authors read and approved the manuscript. He H and Zou CF contributed equally to the study.
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 patients or any disclosure of patients’ information. The informed consent document is not applicable.
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: 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, 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: June 12, 2024
Revised: August 28, 2024
Accepted: September 2, 2024
Published online: October 27, 2024
Processing time: 107 Days and 23.1 Hours
Abstract
BACKGROUND

Early recurrence (ER) is associated with dismal outcomes in patients undergoing radical resection for pancreatic ductal adenocarcinoma (PDAC). Approaches for predicting ER will help clinicians in implementing individualized adjuvant therapies. Postoperative serum tumor markers (STMs) are indicators of tumor progression and may improve current systems for predicting ER.

AIM

To establish an improved nomogram based on postoperative STMs to predict ER in PDAC.

METHODS

We retrospectively enrolled 282 patients who underwent radical resection for PDAC at our institute between 2019 and 2021. Univariate and multivariate Cox regression analyses of variables with or without postoperative STMs, were performed to identify independent risk factors for ER. A nomogram was constructed based on the independent postoperative STMs. Receiver operating characteristic curve analysis was used to evaluate the area under the curve (AUC) of the nomogram. Survival analysis was performed using Kaplan-Meier survival plot and log-rank test.

RESULTS

Postoperative carbohydrate antigen 19-9 and carcinoembryonic antigen levels, preoperative carbohydrate antigen 125 levels, perineural invasion, and pTNM stage III were independent risk factors for ER in PDAC. The postoperative STMs-based nomogram (AUC: 0.774, 95%CI: 0.713-0.835) had superior accuracy in predicting ER compared with the nomogram without postoperative STMs (AUC: 0.688, 95%CI: 0.625-0.750) (P = 0.016). Patients with a recurrence nomogram score (RNS) > 1.56 were at high risk for ER, and had significantly poorer recurrence-free survival [median: 3.08 months, interquartile range (IQR): 1.80-8.15] than those with RNS ≤ 1.56 (14.00 months, IQR: 6.67-24.80), P < 0.001).

CONCLUSION

The postoperative STMs-based nomogram improves the predictive accuracy of ER in PDAC, stratifies the risk of ER, and identifies patients at high risk of ER for tailored adjuvant therapies.

Keywords: Nomogram; Postoperative serum tumor markers; Early recurrence; Predicting accuracy; Adjuvant therapy; Pancreatic ductal adenocarcinoma

Core Tip: Patients with early recurrence (ER) of pancreatic ductal adenocarcinoma, have significantly poor survivals. Adjuvant therapy (AT) may prevent or delay ER, but the absence of AT happens to nearly 50% of patients. Predictive systems for ER remain unsatisfactory, and postoperative serum tumor markers (STMs) may change this dilemma. This study demonstrates that postoperative STMs are independent risk factors for ER. We developed a nomogram based on postoperative STMs and improved predicting accuracy for ER. With this nomogram, clinicians can identify patients at high risk for ER and administer individualized AT.