Prediction of Isolated Local Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Study

I. W.J.M. van Goor; P. C.M. Andel; F. S. Buijs; M. G. Besselink; B. A. Bonsing; K. Bosscha; O. R. Busch; G. A. Cirkel; R. M. van Dam; S. Festen; B. Groot Koerkamp; E. van der Harst; I. H.J.T. de Hingh; G. Kazemier; M. S.L. Liem; G. Meijer; V. E. de Meijer; V. B. Nieuwenhuijs; D. Roos; J. M.J. Schreinemakers; M. W.J. Stommel; F. Wit; R. C. Verdonk; H. C. van Santvoort; I. Q. Molenaar; M. P.W. Intven; L. A. Daamen

doi:10.1245/s10434-024-15664-4

Prediction of Isolated Local Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Study

I. W.J.M. van Goor^*, P. C.M. Andel, F. S. Buijs, M. G. Besselink, B. A. Bonsing, K. Bosscha, O. R. Busch, G. A. Cirkel, R. M. van Dam, S. Festen, B. Groot Koerkamp, E. van der Harst, I. H.J.T. de Hingh, G. Kazemier, M. S.L. Liem, G. Meijer, V. E. de Meijer, V. B. Nieuwenhuijs, D. Roos, J. M.J. SchreinemakersM. W.J. Stommel, F. Wit, R. C. Verdonk, H. C. van Santvoort, I. Q. Molenaar, M. P.W. Intven, L. A. Daamen^*,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Distinguishing postoperative fibrosis from isolated local recurrence (ILR) after resection of pancreatic ductal adenocarcinoma (PDAC) is challenging. A prognostic model that helps to identify patients at risk of ILR can assist clinicians when evaluating patients’ postoperative imaging. This nationwide study aimed to develop a clinically applicable prognostic model for ILR after PDAC resection. Patients and Methods: An observational cohort study was performed, including all patients who underwent PDAC resection in the Netherlands (2014–2019; NCT04605237). On the basis of recurrence location (ILR, systemic, or both), multivariable cause-specific Cox-proportional hazard analysis was conducted to identify predictors for ILR and presented as hazard ratios (HRs) with 95% confidence intervals (CIs). A predictive model was developed using Akaike’s Information Criterion, and bootstrapped discrimination and calibration indices were assessed. Results: Among 1194/1693 patients (71%) with recurrence, 252 patients (21%) developed ILR. Independent predictors for ILR were resectability status (borderline versus resectable, HR 1.42; 95% CI 1.03–1.96; P = 0.03, and locally advanced versus resectable, HR 1.11; 95% CI 0.68–1.82; P = 0.66), tumor location (head versus body/tail, HR 1.50; 95% CI 1.00–2.25; P = 0.05), vascular resection (HR 1.86; 95% CI 1.41–2.45; P < 0.001), perineural invasion (HR 1.47; 95% CI 1.01–2.13; P = 0.02), number of positive lymph nodes (HR 1.04; 95% CI 1.01–1.08; P = 0.02), and resection margin status (R1 < 1 mm versus R0 ≥ 1 mm, HR 1.64; 95% CI 1.25–2.14; P < 0.001). Moderate performance (concordance index 0.66) with adequate calibration (slope 0.99) was achieved. Conclusions: This nationwide study identified factors predictive of ILR after PDAC resection. Our prognostic model, available through www.pancreascalculator.com, can be utilized to identify patients with a higher a priori risk of developing ILR, providing important information in patient evaluation and prognostication.

Original language	English
Pages (from-to)	8264-8275
Number of pages	12
Journal	Annals of surgical oncology
Volume	31
Issue number	12
Early online date	27 Jun 2024
DOIs	https://doi.org/10.1245/s10434-024-15664-4
Publication status	Published - Nov 2024

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van Goor, I. W. J. M., Andel, P. C. M., Buijs, F. S., Besselink, M. G., Bonsing, B. A., Bosscha, K., Busch, O. R., Cirkel, G. A., van Dam, R. M., Festen, S., Koerkamp, B. G., van der Harst, E., de Hingh, I. H. J. T., Kazemier, G., Liem, M. S. L., Meijer, G., de Meijer, V. E., Nieuwenhuijs, V. B., Roos, D. (2024). Prediction of Isolated Local Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Study. Annals of surgical oncology, 31(12), 8264-8275. https://doi.org/10.1245/s10434-024-15664-4

@article{6e90bb20aec6401a8da174f1af729448,

title = "Prediction of Isolated Local Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Study",

abstract = "Background: Distinguishing postoperative fibrosis from isolated local recurrence (ILR) after resection of pancreatic ductal adenocarcinoma (PDAC) is challenging. A prognostic model that helps to identify patients at risk of ILR can assist clinicians when evaluating patients{\textquoteright} postoperative imaging. This nationwide study aimed to develop a clinically applicable prognostic model for ILR after PDAC resection. Patients and Methods: An observational cohort study was performed, including all patients who underwent PDAC resection in the Netherlands (2014–2019; NCT04605237). On the basis of recurrence location (ILR, systemic, or both), multivariable cause-specific Cox-proportional hazard analysis was conducted to identify predictors for ILR and presented as hazard ratios (HRs) with 95% confidence intervals (CIs). A predictive model was developed using Akaike{\textquoteright}s Information Criterion, and bootstrapped discrimination and calibration indices were assessed. Results: Among 1194/1693 patients (71%) with recurrence, 252 patients (21%) developed ILR. Independent predictors for ILR were resectability status (borderline versus resectable, HR 1.42; 95% CI 1.03–1.96; P = 0.03, and locally advanced versus resectable, HR 1.11; 95% CI 0.68–1.82; P = 0.66), tumor location (head versus body/tail, HR 1.50; 95% CI 1.00–2.25; P = 0.05), vascular resection (HR 1.86; 95% CI 1.41–2.45; P < 0.001), perineural invasion (HR 1.47; 95% CI 1.01–2.13; P = 0.02), number of positive lymph nodes (HR 1.04; 95% CI 1.01–1.08; P = 0.02), and resection margin status (R1 < 1 mm versus R0 ≥ 1 mm, HR 1.64; 95% CI 1.25–2.14; P < 0.001). Moderate performance (concordance index 0.66) with adequate calibration (slope 0.99) was achieved. Conclusions: This nationwide study identified factors predictive of ILR after PDAC resection. Our prognostic model, available through www.pancreascalculator.com, can be utilized to identify patients with a higher a priori risk of developing ILR, providing important information in patient evaluation and prognostication.",

author = "{van Goor}, {I. W.J.M.} and Andel, {P. C.M.} and Buijs, {F. S.} and Besselink, {M. G.} and Bonsing, {B. A.} and K. Bosscha and Busch, {O. R.} and Cirkel, {G. A.} and {van Dam}, {R. M.} and S. Festen and Koerkamp, {B. Groot} and {van der Harst}, E. and {de Hingh}, {I. H.J.T.} and G. Kazemier and Liem, {M. S.L.} and G. Meijer and {de Meijer}, {V. E.} and Nieuwenhuijs, {V. B.} and D. Roos and Schreinemakers, {J. M.J.} and Stommel, {M. W.J.} and F. Wit and Verdonk, {R. C.} and {van Santvoort}, {H. C.} and Molenaar, {I. Q.} and Intven, {M. P.W.} and Daamen, {L. A.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = nov,

doi = "10.1245/s10434-024-15664-4",

language = "English",

volume = "31",

pages = "8264--8275",

journal = "Annals of surgical oncology",

issn = "1068-9265",

publisher = "Springer New York",

number = "12",

}

van Goor, IWJM, Andel, PCM, Buijs, FS, Besselink, MG, Bonsing, BA, Bosscha, K, Busch, OR, Cirkel, GA, van Dam, RM, Festen, S, Koerkamp, BG, van der Harst, E, de Hingh, IHJT, Kazemier, G, Liem, MSL, Meijer, G, de Meijer, VE, Nieuwenhuijs, VB, Roos, D, Schreinemakers, JMJ, Stommel, MWJ, Wit, F, Verdonk, RC, van Santvoort, HC , Molenaar, IQ , Intven, MPW , Daamen, LA 2024, 'Prediction of Isolated Local Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Study', Annals of surgical oncology, vol. 31, no. 12, pp. 8264-8275. https://doi.org/10.1245/s10434-024-15664-4

TY - JOUR

T1 - Prediction of Isolated Local Recurrence After Resection of Pancreatic Ductal Adenocarcinoma

T2 - A Nationwide Study

AU - van Goor, I. W.J.M.

AU - Andel, P. C.M.

AU - Buijs, F. S.

AU - Besselink, M. G.

AU - Bonsing, B. A.

AU - Bosscha, K.

AU - Busch, O. R.

AU - Cirkel, G. A.

AU - van Dam, R. M.

AU - Festen, S.

AU - Koerkamp, B. Groot

AU - van der Harst, E.

AU - de Hingh, I. H.J.T.

AU - Kazemier, G.

AU - Liem, M. S.L.

AU - Meijer, G.

AU - de Meijer, V. E.

AU - Nieuwenhuijs, V. B.

AU - Roos, D.

AU - Schreinemakers, J. M.J.

AU - Stommel, M. W.J.

AU - Wit, F.

AU - Verdonk, R. C.

AU - van Santvoort, H. C.

AU - Molenaar, I. Q.

AU - Intven, M. P.W.

AU - Daamen, L. A.

PY - 2024/11

Y1 - 2024/11

N2 - Background: Distinguishing postoperative fibrosis from isolated local recurrence (ILR) after resection of pancreatic ductal adenocarcinoma (PDAC) is challenging. A prognostic model that helps to identify patients at risk of ILR can assist clinicians when evaluating patients’ postoperative imaging. This nationwide study aimed to develop a clinically applicable prognostic model for ILR after PDAC resection. Patients and Methods: An observational cohort study was performed, including all patients who underwent PDAC resection in the Netherlands (2014–2019; NCT04605237). On the basis of recurrence location (ILR, systemic, or both), multivariable cause-specific Cox-proportional hazard analysis was conducted to identify predictors for ILR and presented as hazard ratios (HRs) with 95% confidence intervals (CIs). A predictive model was developed using Akaike’s Information Criterion, and bootstrapped discrimination and calibration indices were assessed. Results: Among 1194/1693 patients (71%) with recurrence, 252 patients (21%) developed ILR. Independent predictors for ILR were resectability status (borderline versus resectable, HR 1.42; 95% CI 1.03–1.96; P = 0.03, and locally advanced versus resectable, HR 1.11; 95% CI 0.68–1.82; P = 0.66), tumor location (head versus body/tail, HR 1.50; 95% CI 1.00–2.25; P = 0.05), vascular resection (HR 1.86; 95% CI 1.41–2.45; P < 0.001), perineural invasion (HR 1.47; 95% CI 1.01–2.13; P = 0.02), number of positive lymph nodes (HR 1.04; 95% CI 1.01–1.08; P = 0.02), and resection margin status (R1 < 1 mm versus R0 ≥ 1 mm, HR 1.64; 95% CI 1.25–2.14; P < 0.001). Moderate performance (concordance index 0.66) with adequate calibration (slope 0.99) was achieved. Conclusions: This nationwide study identified factors predictive of ILR after PDAC resection. Our prognostic model, available through www.pancreascalculator.com, can be utilized to identify patients with a higher a priori risk of developing ILR, providing important information in patient evaluation and prognostication.

AB - Background: Distinguishing postoperative fibrosis from isolated local recurrence (ILR) after resection of pancreatic ductal adenocarcinoma (PDAC) is challenging. A prognostic model that helps to identify patients at risk of ILR can assist clinicians when evaluating patients’ postoperative imaging. This nationwide study aimed to develop a clinically applicable prognostic model for ILR after PDAC resection. Patients and Methods: An observational cohort study was performed, including all patients who underwent PDAC resection in the Netherlands (2014–2019; NCT04605237). On the basis of recurrence location (ILR, systemic, or both), multivariable cause-specific Cox-proportional hazard analysis was conducted to identify predictors for ILR and presented as hazard ratios (HRs) with 95% confidence intervals (CIs). A predictive model was developed using Akaike’s Information Criterion, and bootstrapped discrimination and calibration indices were assessed. Results: Among 1194/1693 patients (71%) with recurrence, 252 patients (21%) developed ILR. Independent predictors for ILR were resectability status (borderline versus resectable, HR 1.42; 95% CI 1.03–1.96; P = 0.03, and locally advanced versus resectable, HR 1.11; 95% CI 0.68–1.82; P = 0.66), tumor location (head versus body/tail, HR 1.50; 95% CI 1.00–2.25; P = 0.05), vascular resection (HR 1.86; 95% CI 1.41–2.45; P < 0.001), perineural invasion (HR 1.47; 95% CI 1.01–2.13; P = 0.02), number of positive lymph nodes (HR 1.04; 95% CI 1.01–1.08; P = 0.02), and resection margin status (R1 < 1 mm versus R0 ≥ 1 mm, HR 1.64; 95% CI 1.25–2.14; P < 0.001). Moderate performance (concordance index 0.66) with adequate calibration (slope 0.99) was achieved. Conclusions: This nationwide study identified factors predictive of ILR after PDAC resection. Our prognostic model, available through www.pancreascalculator.com, can be utilized to identify patients with a higher a priori risk of developing ILR, providing important information in patient evaluation and prognostication.

UR - http://www.scopus.com/inward/record.url?scp=85197310131&partnerID=8YFLogxK

U2 - 10.1245/s10434-024-15664-4

DO - 10.1245/s10434-024-15664-4

M3 - Article

C2 - 38937412

AN - SCOPUS:85197310131

SN - 1068-9265

VL - 31

SP - 8264

EP - 8275

JO - Annals of surgical oncology

JF - Annals of surgical oncology

IS - 12

ER -

Prediction of Isolated Local Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Study

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