Quantitative definitions of pain, CA19-9, and tumor size as high-risk features of resectable pancreatic cancer: a single-center retrospective cohort study

Background Pancreatic ductal adenocarcinoma (PDAC) is one of malignant tumors with the worst prognosis. Surgery and adjuvant chemotherapy are the main treatments for resectable pancreatic cancer. For borderline resectable PDAC, neoadjuvant chemotherapy has been advised. For clearly resectable PDAC, neoadjuvant chemotherapy also might be considered for the patients with high-risk features, but with no precise quantitative criteria to define these features. So, this study aimed to re-evaluate the relationship between high-risk features and prognosis of clearly resectable pancreatic cancer, and to define the precise criteria for these high-risk features. Methods Data from 211 patients with clearly resectable pancreatic cancer were reviewed to assess the relationship between overall survival (OS) after surgery and high-risk features, and cut-off values were determined for high-risk features that were associated with poor prognosis of clearly resectable pancreatic cancer. Results Lymph node metastasis (LNM), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and primary tumor size ≥6 cm were significant variables related to OS. CA19-9 ≥1,000 U/mL was statistically related to prognosis, as was CA19-9 ≥500 U/mL without obstructive jaundice. There was no significant relationship between abdominal and/or back pain and OS, but patients with moderate or severe pain accompanied by tumor size ≥4 cm or 10 times higher CA19-9 levels had worse prognosis. Conclusions For clearly resectable pancreatic cancer with R0 resection, the high-risk features were clarified. Abdominal and/or back pain may not be used as a prognostic indicator alone, though combined with CA19-9 or tumor size it may be more valuable for predicting prognosis.