Long-term disease-free survival after resection of pancreatic ductal adenocarcinoma
Objective: To develop a prediction model for long-term disease-free survival (DFS) after resection of pancreatic ductal adenocarcinoma (PDAC).

Background: Despite high recurrence rates, approximately 10% of patients have DFS ≥ five years after PDAC resection. A long-term DFS prediction model may aid clinicians in surveillance- and treatment-related decisions.

Methods: This nationwide cohort study included all consecutive patients who underwent PDAC resection in the Netherlands (2014-2016). The best performing prognostic model was selected by Cox proportional hazard analysis and Akaike’s information criterion and presented by hazard ratio’s (HR) with 95% confidence interval (CI). Internal validation of the model was performed using 1000 bootstrap samples, and discrimination and calibration indices were assessed.

Results: Overall, 836 patients with a median follow-up of 67 months (interquartile range 51-79) were analyzed. DFS ≥ five years was seen in 118 patients (14%). Factors independently associated with DFS ≥ five years were low preoperative carbohydrate antigen 19-9 (logarithmic; HR 1.21; 95%CI 1.10-1.32), absence of vascular resection (HR 1.33; 95%CI 1.12-1.58), T1 tumor stage (versus T3; HR 1.52; 95%CI 1.14-2.04), well/moderate tumor differentiation (versus poor; HR 1.44; 95%CI 1.22-1.68), absence of perineural invasion (HR 1.42; 95%CI 1.11-1.81), N0 and N1 nodal status (versus N2; HR 1.92; 95%CI 1.54-2.40, and HR 1.33; 95%CI 1.11-1.60, respectively), R0≥1 mm resection margin status (versus R1<1 mm; HR 1.25; 95%CI 1.07-1.46), and adjuvant chemotherapy (HR 1.74; 95%CI 1.47-2.06). Moderate performance (concordance index 0.68) with adequate calibration (calibration slope 0.99) was achieved.

Conclusion: The developed prediction model, readily available at www.pancreascalculator.com, can be used to estimate the probability of DFS ≥ five years after PDAC resection. This may aid prognostication and shared decision-making for individual patients after PDAC resection.
Research authors: Iris W.J.M. van Goor, Thijs J. Schouten, Hjalmar C. van Santvoort, Lois A. Daamen, I. Quintus Molenaar
Version: 1.58
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chance of reaching a disease-free survival of at least five years after resection of pancreatic ductal adenocarcinoma

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