Predicting recurrence patterns and outcomes following resection of pancreatic ductal adenocarcinoma: a contemporary real-world data cohort study

Introduction: The prognosis in pancreatic ductal adenocarcinoma (PDAC) remains poor with 2-year recurrence rates around 80% despite curative-intent surgery. This study evaluated factors associated with early recurrence in a contemporary, multi-center, Australasian population. A better understanding of patients at risk of early recurrence (ER) could improve selection of operative candidates. Methods: De-identified data were extracted from 23 hospitals participating in the PURPLE pancreatic cancer registry between 2016 and 2024. Clinicopathological features, treatment, recurrence patterns, and survival were examined. ER was defined as cancer recurrence within 12 months of surgery. Results: Of 3041 patients identified, 539 completed curative intent surgery. At a median follow-up of 21.8 months, 74% of resected cases had recurred. The median recurrence free survival was 14.3 months. ER occurred in 41% of patients and was associated with advanced age ( P = 0.04), worse performance status ( P < 0.01), T3–T4 stage ( P = 0.01), CA19-9 > 300 U/ml ( P < 0.01), involvement of more than two lymph nodes ( P < 0.01), lymphovascular invasion ( P = 0.01), and no neoadjuvant and/or adjuvant treatment ( P < 0.01). There was a significant association between the primary tumor location and recurrence site ( P = 0.046). The median OS of those with isolated lung (31.4 months) and locoregional (29.2 months) recurrences was longer than those with liver (21.3 months) or peritoneal (20.7 months) recurrences ( P = 0.01). The use of neoadjuvant and adjuvant therapy was associated with lower ER rates ( P < 0.01). Conclusion: A high proportion of resected PDAC patients experienced ER. Multiple pathological factors can predict ER. Primary tumor location was associated with site of recurrence. Neoadjuvant and adjuvant therapy significantly reduced ER and increased OS.