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Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive and challenging cancers, causing substantial mortality worldwide. Despite advancements in treatment modalities, the prognosis for patients with PDAC remains dismal, emphasizing the critical need for identifying factors influencing early recurrence and survival post-surgery. This study aimed to clarify the risk factors for early recurrence (within 1 year) in patients who underwent upfront surgery for resectable PDAC. Methods:We retrospectively enrolled 127 patients who underwent upfront R0/R1 resection for resectable PDAC at our institute between January 2005 and December 2019. We collected clinicopathological background data and performed univariate and multivariate analyses to evaluate the risk factors for early recurrence. Results:The median follow-up period was 27 months. The overall and recurrence-free survival rates at 1, 3, and 5 years were 82%, 56%, and 33% and 68%, 33%, and 24%, respectively. Multivariate analysis revealed that CA19-9 ≥ 50U/mL and positive anterior peripancreatic surface invasion (T3) were independent risk factors. A prognostic staging model using one point for each risk factor provided a well-categorized predictive model. When all patients were classified into three groups (Score 0: neither CA19-9 ≥ 50 nor T3 factors; Score 1: one factor; and Score 2: both factors), the 5-year overall survival rates were 45%, 41%, and 22% for scores of 0, 1, and 2, respectively (p < 0.001). The corresponding 5-year recurrence-free survival rates were 45%, 30%, and 9%, respectively (p < 0.001). Conclusion:High preoperative CA19-9 level and peripancreatic infiltration were independent risk factors for early recurrence after upfront surgery.