Predicting Long-term Disease-free Survival After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Cohort Study : Annals of Surgery

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Predicting Long-term Disease-free Survival After Resection of Pancreatic Ductal Adenocarcinoma

A Nationwide Cohort Study

van Goor, Iris W.J.M. MD*,†; Schouten, Thijs J. MD*; Verburg, Daphne N. BSc*; Besselink, Marc G. MD, PhD‡,§; Bonsing, Bert A. MD, PhD∥; Bosscha, Koop MD, PhD; Brosens, Lodewijk A.A. MD, PhD#; Busch, Olivier R. MD, PhD‡,§; Cirkel, Geert A. MD, PhD**; van Dam, Ronald M. MD, PhD††; Festen, Sebastiaan MD, PhD‡‡; Koerkamp, Bas Groot MD, PhD§§; van der Harst, Erwin MD, PhD∥∥; de Hingh, Ignace H.J.T. MD, PhD¶¶; Intven, Martijn P.W. MD, PhD†; Kazemier, Geert MD, PhD§,##; Los, Maartje MD, PhD***; Meijer, Gert J. PhD†; de Meijer, Vincent E. MD, PhD†††; Nieuwenhuijs, Vincent B. MD, PhD‡‡‡; Roos, Daphne MD, PhD§§§; Schreinemakers, Jennifer M.J. MD, PhD∥∥∥; Stommel, Martijn W.J. MD, PhD¶¶¶; Verdonk, Robert C. MD, PhD###; van Santvoort, Hjalmar C. MD, PhD*; Daamen, Lois A. MD, PhD*,****; Molenaar, I. Quintus MD, PhD*;  for the Dutch Pancreatic Cancer Group

Author Information

*Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, the Netherlands

†Department of Radiation Oncology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands

‡Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands

§Cancer Center Amsterdam, the Netherlands

∥Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands

Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands

#Department of Pathology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, the Netherlands

**Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & Meander Medical Center Amersfoort, Utrecht, the Netherlands

††Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands

‡‡Department of Surgery, OLVG, Amsterdam, the Netherlands

§§Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands

∥∥Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands

¶¶Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands

##Amsterdam UMC, location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands

***Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Utrecht University, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, the Netherlands

†††Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

‡‡‡Department of Surgery, Isala, Zwolle, the Netherlands

§§§Department of Surgery, Renier de Graaf Gasthuis, Delft, the Netherlands

∥∥∥Department of Surgery, Amphia Hospital, Breda, the Netherlands

¶¶¶Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands

###Department of Gastroenterology, Regional Academic Cancer Center Utrecht, Utrecht, the Netherlands

****Imaging Division, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands

During review process: Iris W.J.M. van Goor, MD, Department of Surgery, Regional Academic Cancer Center Utrecht (University Medical Center Utrecht and Sint Antonius Hospital Nieuwegein) PO Box 85500, 3508 GA Utrecht, the Netherlands Telephone number: 0031 (0) 631917882; e-mail: [email protected].

Funding statement: None declared.

Ethics statement: This study was done in in accord with the ethical standards of the Helsinki Declaration of 1975.

Data access statement: All relevant data is included in the article and its supplementary information files.

Conflicts of interest: None declared.

[email protected]

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This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0/

Annals of Surgery ():10.1097/SLA.0000000000006004, July 17, 2023. | DOI: 10.1097/SLA.0000000000006004
  • Open
  • SDC
  • PAP

Abstract

Objective: 

To develop a prediction model for long-term (≥5 years) disease-free survival (DFS) after resection of pancreatic ductal adenocarcinoma (PDAC).

Summary Background Data: 

Despite high recurrence rates, approximately 10% of patients have long-term DFS after PDAC resection. A model to predict long-term DFS may aid individualized prognostication and shared decision-making.

Methods: 

This nationwide cohort study included all consecutive patients who underwent PDAC resection in the Netherlands (2014-2016). The best performing prognostic model was selected by Cox-proportional hazard analysis and Akaike’s Information Criterion, presented by hazard ratio’s (HR) with 95% confidence interval (CI). Internal validation was performed, and discrimination and calibration indices were assessed.

Results: 

836 patients with a median follow-up of 67 months (interquartile range 51-79) were analyzed. Long-term DFS was seen in 118 patients (14%). Factors predictive of long-term DFS were low preoperative carbohydrate antigen 19-9 (logarithmic; HR1.21; 95%CI 1.10-1.32), no vascular resection (HR1.33; 95%CI 1.12-1.58), T1 or T2 tumor stage (HR1.52; 95%CI 1.14-2.04, and HR1.17; 95%CI 0.98-1.39, respectively), well/moderate tumor differentiation (HR1.44; 95%CI 1.22-1.68), absence of perineural and lymphovascular invasion (HR1.42; 95%CI 1.11-1.81 and HR1.14; 95%CI 0.96-1.36, respectively), N0 or N1 nodal status (HR1.92; 95%CI 1.54-2.40, and HR1.33; 95%CI 1.11-1.60, respectively), R0 resection margin status (HR1.25; 95%CI 1.07-1.46), no major complications (HR1.14; 95%CI 0.97-1.35) and adjuvant chemotherapy (HR1.74; 95%CI 1.47-2.06). Moderate performance (concordance index 0.68) with adequate calibration (slope 0.99) was achieved.

Conclusions: 

The developed prediction model, readily available at www.pancreascalculator.com, can be used to estimate the probability of long-term disease-free survival after resection of pancreatic ductal adenocarcinoma.

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.