Postoperative early recurrence (ER) in patients with pancreatic ductal adenocarcinoma (PDAC) is frequently encountered after curative intent surgery. Nonetheless, clinical significance and risk factors of ER after surgery for PDAC have not been extensively investigated. The aim of this study was to determine preoperative risk predictors for ER in patients with PDAC after upfront surgery.

Eighty-one consecutive patients with PDAC who underwent curative intent surgical resection at Kangbuk Samsung Hospital between January 2004 and May 2015 were enrolled. ER was defined as tumor relapse within 6 months after surgery.

ER occurred in 26 patients (32.1%), whereas 49 patients (60.5%) had late recurrence (≥?6 months after surgery), and 6 patients had no recurrence (7.4%). Univariate analysis showed that C-reactive protein (CRP)?>?3.0?mg/dL, modified Glasgow prognostic score (mGPS)?=?2, decrease of total lymphocyte count by?>?50% of baseline value in the preoperative period, prognostic nutritional index (PNI) 〈 45, neutrophil-to-lymphocyte ratio (NLR)?≥?3, and preoperative maximum standardized uptake value (SUVmax) were significantly associated with ER. Multivariate logistic regression analysis revealed that CRP 〉 3.0?mg/dL, decrease of total lymphocyte count by?>?50% of baseline value, and preoperative SUVmax were significant and independent contributors of ER in patients with resectable PDAC who underwent curative intent surgery.

Postoperative ER for resectable PDAC was frequent with poor prognosis after curative intent upfront surgery. It is reasonable to suggest that there is a subgroup of resectable PDAC patients at high-risk of ER and neoadjuvant therapy should be considered in these patients in a clinical trial setting.