A risk score system including CT features for predicting early recurrence of resectable pancreatic ductal adenocarcinoma after radical resection: a dual-center retrospective study.

PURPOSE

To develop a score system including CT features for predicting postoperative early (≤ 1 year) recurrence-free survival (RFS) in resectable pancreatic ductal adenocarcinoma (PDAC) patients who underwent radical resection and assess its performance.

MATERIALS AND METHODS

This dual-center, retrospective study included patients with resectable PDAC who underwent radical resection from September 2016 to April 2023. All CT features were independently evaluated by two blinded radiologists. An early recurrence score (ERS) based on CT and clinical features, for predicting early recurrence risk, was developed by Cox regression analysis in the developing cohort, and was validated in the testing and validation cohorts and compared with AJCC TNM staging system.

RESULTS

This study included 210 patients in the development cohort (mean age ± standard deviation, 60 ± 10 years; 129 men), 92 patients in the testing cohort (60 ± 9 years; 60 men), and 31 patients in the validation cohort (62 ± 7 years; 20 men). CA19-9 (hazard ratio [HR], 1.57; p = 0.044), perineural invasion on CT (HR, 1.83; p = 0.037), tumor necrosis (HR, 3.20; p < 0.001), and lymph nodes metastasis on CT (HR, 1.84; p = 0.004) formed the ERS. Its AUC of 0.851 and 0.901, superior to AJCC TNM staging (AUC of 0.630 and 0.534) in the testing and validation cohorts, (p < 0.05), respectively. The high-risk patients predicted by ERS had significantly higher postoperative 1-year recurrence rates than their low-risk counterparts in both the testing cohort (81.4% vs 22.5%, p < 0.001) and the validation cohort (81.2% vs 26.7%, p = 0.003).

CONCLUSION

The ERS noninvasively predicted early recurrence in resectable PDAC, outperforming the AJCC TNM system.

KEY POINTS

Question More accurately risk-stratifying PDAC patients would allow for better treatment planning. Findings Perineural invasion on CT, lymph nodes metastasis on CT, tumor necrosis, and CA19-9 were associated with early recurrence of resectable PDAC. Clinical relevance The ERS system showed better predictive performance for early recurrence in resectable PDAC and outperformed the American Joint Commission on Cancer TNM system.