Preoperative computed tomography-based risk stratification model validation for postoperative pancreatic ductal adenocarcinoma recurrence.

BACKGROUND

The computed tomography (CT)-based preoperative risk score was developed to predict recurrence after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma (PDAC) in South Korea. However, whether it performs well in other countries remains unknown.

AIM

To externally validate the CT-based preoperative risk score for PDAC in a country outside South Korea.

METHODS

Consecutive patients with PDAC who underwent upfront surgery from January 2016 to December 2019 at our institute in a country outside South Korea were retrospectively included. The study utilized the CT-based risk scoring system, which incorporates tumor size, portal venous phase density, tumor necrosis, peripancreatic infiltration, and suspicious metastatic lymph nodes. Patients were categorized into prognosis groups based on their risk score, as good (risk score < 2), moderate (risk score 2-4), and poor (risk score ≥ 5).

RESULTS

A total of 283 patients were evaluated, comprising 170 males and 113 females, with an average age of 63.52 ± 8.71 years. Follow-up was conducted until May 2023, and 76% of patients experienced tumor recurrence with median recurrence-free survival (RFS) of 29.1 ± 1.9 months. According to the evaluation results of Reader 1, the recurrence rates were 39.0% in the good prognosis group, 82.1% in the moderate group, and 84.5% in the poor group. In comparison, Reader 2 reported recurrence rates of 50.0%, 79.5%, and 88.9%, respectively, across the same prognostic categories. The study validated the effectiveness of the risk scoring system, demonstrating better RFS in the good prognosis group.

CONCLUSION

This research validated that the CT-based preoperative risk scoring system can effectively predict RFS in patients with PDAC, suggesting that it may be valuable in diverse populations.