Prognostic factors for early recurrence after resection of pancreatic cancer
Leonhardt CS et al, Gastroenterology. 2024;167(5):977-992
This meta-analysis revealed that preoperative CA19-9 serum concentrations, lymph node status, non-delivery of adjuvant therapy, grading and tumor size based on imaging were key prognostic factors of pancreatic cancer recurrence following resection.
Background and aims: More than half of pancreatic ductal adenocarcinomas (PDACs) recur within 12 months after curative-intent resection. This systematic review and meta-analysis was conducted to identify all reported prognostic factors for early recurrence in resected PDACs.
Methods: After a systematic literature search, a meta-analysis was conducted using a random-effects model. Separate analyses were performed for adjusted versus unadjusted effect estimates as well as reported odds ratios (ORs) and hazard ratios (HRs). Risk of bias was assessed using the Quality in Prognostic Studies tool, and evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation recommendations.
Results: After 2903 abstracts were screened, 65 studies were included. Of these, 28 studies (43.1%) defined early recurrence as evidence of recurrence within 6 months, whereas 34 (52.3%) defined it as evidence of recurrence within 12 months after surgery. Other definitions were uncommon. Analysis of unadjusted ORs and HRs revealed 41 and 5 prognostic factors for early recurrence within 6 months, respectively. When exclusively considering adjusted data, the authors identified 25 and 10 prognostic factors based on OR and HR, respectively. Using a 12-month definition, they identified 38 (OR) and 15 (HR) prognostic factors from unadjusted data and 38 (OR) and 30 (HR) prognostic factors from adjusted data, respectively. On the basis of frequency counts of adjusted data, preoperative carbohydrate antigen 19-9, N status, non-delivery of adjuvant therapy, grading, and tumor size based on imaging were identified as key prognostic factors for early recurrence.
Conclusions: Reported prognostic factors of early recurrence vary considerably. Identified key prognostic factors could aid in the development of a risk stratification framework for early recurrence. However, prospective validation is necessary.