Effect of risk factor score on early recurrence after pancreatectomy for invasive pancreatic ductal adenocarcinoma

Purpose: This study aimed to identify the risk factors after pancreatic ductal adenocarcinoma (PDAC) resection to create a novel scoring system for early recurrence (ER) and analyze their effect on the recurrent pattern. Methods This retrospective study included 60 patients with PDAC who underwent pancreatectomy. The predicted risk factors for ER which recurred within 12 months, were analyzed. The scoring system included significantly predictive factors. The cutoff values were determined using the receiving operating characteristic (ROC) curve. A score was added by one point for each anomaly. Overall survival (OS) was compared according to the score. The relationship between the score and the recurrent pattern was investigated. Results ER was determined in 26. Independent predictors included preoperative maximum carbohydrate antigen 19 − 9 (CA19-9) of ≥ 147 U/mL, lymph node ratio (LNR) of ≥ 0.1277, and no adjuvant chemotherapy (AC). The 5-year OS rates with a score of 0, 1, and 2 were 55.8%, 11.0%, and 0%, respectively. The classified subgroups using the two factors, except for AC, initiated AC at ≤ 58 postoperative days, which was determined as a cutoff value using a ROC curve, and the number of recurrent regions significantly reduced in the higher-risk groups and the prognosis significantly improved in the moderate risk group. Conclusions Preoperative maximum CA19-9 of ≥ 147 U/mL, LNR of ≥ 0.1277 and no AC could be ER predictors. OS was significantly stratified using the scoring system with the three factors. Early AC initiation in the moderate-risk group of ER might suppress multiregional metastasis recurrence and improve the prognosis.