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



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.


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.


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.


The developed prediction model, readily available at, 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.