Preoperative Predictive Nomogram (DASINEL Score) for Early Recurrence in Pancreatic Cancer.

Background/aim: Early recurrence (ER) following radical resection of pancreatic cancer (PC) is associated with poor survival outcomes, regardless of whether patients receive upfront surgery or neoadjuvant therapy (NAT). This study aimed to explore risk factors for ER across all treatment settings for PC.

Patients and methods: In this retrospective study, 146 patients who underwent radical resection of PC were enrolled at the Shiga University of Medical Science Hospital. ER was defined as recurrence within 6 months of surgery. Preoperative evaluation factors were compared between the ER and non-ER groups. A preoperative ER prediction nomogram was developed.

Results: Overall, 36 of the 147 patients (24.7%) experienced ER. The median survival time (MST) and post-recurrence survival time were shorter in the ER group than in the non-ER group (p<0.001 and p=0.033, respectively). Multivariate analysis revealed abnormal duke pancreatic monoclonal antigen type 2 levels (p=0.041), tumor size (p=0.003), and neutrophil/lymphocyte ratio ≥4 (p=0.016) as independent predictive factors for ER following radical resection. Subsequently, an ER-predicting nomogram was developed, called the DASINEL score. The incidence of ER was associated with the DASINEL score (Cochran-Armitage test, p<0.001). The MST was significantly shorter in the DASINEL score ≥60 group than in the <60 group (15.3 vs. 39.8 months, p<0.001), even in patients receiving NAT (p= 0.005) and those with resectable PC (p<0.001).

Conclusion: The DASINEL score may be a valuable tool for predicting ER across all treatment scenarios for PC.