Early Recurrence After Resection of Locally Advanced Pancreatic Cancer Following Induction Therapy: An International Multicenter Study

Leonard W F Seelen, A Floortje van Oosten, Lilly J H Brada, Vincent P Groot, Lois A Daamen, Marieke S Walma, Bastiaan F van der Lek, Mike S L Liem, Gijs A Patijn, Martijn W J Stommel, Ronald M van Dam, Bas Groot Koerkamp, Olivier R Busch, Ignace H J T de Hingh, Casper H J van Eijck, Marc G Besselink, Richard A Burkhart, Inne H M Borel Rinkes, Christopher L Wolfgang, I Quintus MolenaarJin He, Hjalmar C van Santvoort

Research output: Contribution to journalArticleAcademicpeer-review


Objective: To establish an evidence-based cutoff and predictors for early recurrence in patients with resected locally advanced pancreatic cancer (LAPC). Background: It is unclear how many and which patients develop early recurrence after LAPC resection. Surgery in these patients is probably of little benefit. Methods: We analyzed all consecutive patients undergoing resection of LAPC after induction chemotherapy who were included in prospective databases in The Netherlands (2015-2019) and the Johns Hopkins Hospital (2016-2018). The optimal definition for "early recurrence"was determined by the post-recurrence survival (PRS). Patients were compared for overall survival (OS). Predictors for early recurrence were evaluated using logistic regression analysis. Results: Overall, 168 patients were included. After a median follow-up of 28 months, recurrence was observed in 118 patients (70.2%). The optimal cutoff for recurrence-free survival to differentiate between early (n=52) and late recurrence (n=66) was 6 months (P<0.001). OS was 8.4 months [95% confidence interval (CI): 7.3-9.6] in the early recurrence group (n=52) versus 31.1 months (95% CI: 25.7-36.4) in the late/no recurrence group (n=116) (P<0.001). A preoperative predictor for early recurrence was postinduction therapy carbohydrate antigen (CA) 19-9≥100 U/mL [odds ratio (OR)=4.15, 95% CI: 1.75-9.84, P=0.001]. Postoperative predictors were poor tumor differentiation (OR=4.67, 95% CI: 1.83-11.90, P=0.001) and no adjuvant chemotherapy (OR=6.04, 95% CI: 2.43-16.55, P<0.001). Conclusions: Early recurrence was observed in one third of patients after LAPC resection and was associated with poor survival. Patients with post-induction therapy CA 19-9 ≥100 U/mL, poor tumor differentiation and no adjuvant therapy were especially at risk. This information is valuable for patient counseling before and after resection of LAPC.

Original languageEnglish
Pages (from-to)118-126
Number of pages9
JournalAnnals of surgery
Issue number1
Early online date11 Aug 2022
Publication statusPublished - 1 Jul 2023


  • Antineoplastic Combined Chemotherapy Protocols/therapeutic use
  • Combined Modality Therapy
  • Humans
  • Induction Chemotherapy
  • Neoadjuvant Therapy
  • Pancreas/pathology
  • Pancreatic Neoplasms/drug therapy
  • locally advanced pancreatic cancer
  • early recurrence
  • pancreatic ductal adenocarcinoma
  • recurrence-free survival
  • overall survival
  • postrecurrence survival
  • pancreatectomy


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