Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2025; 17(7): 107804
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.107804
Preoperative computed tomography-based risk stratification model validation for postoperative pancreatic ductal adenocarcinoma recurrence
Xiao-Hui Liu, Jing-Hong Xie, Xi-Song Zhu, Li-Heng Liu
Xiao-Hui Liu, Xi-Song Zhu, Department of Radiology, Wenzhou Medical University Affiliated Quzhou Hospital (Quzhou People's Hospital), Quzhou 324000, Zhejiang Province, China
Xiao-Hui Liu, Li-Heng Liu, Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200000, China
Jing-Hong Xie, Department of Radiology, Qingdao Eighth People's Hospital, Qingdao 266000, Shandong Province, China
Author contributions: Liu LH designed the study, participated in data analysis, and drafted and critically revised the manuscript for important intellectual content; Liu XH and Xie JH collected the patients’ clinical data; Zhu XS served as a scientific advisor and contributed to the interpretation of results; All authors reviewed and approved the final version of the manuscript and agree to be accountable for all aspects of the work.
Institutional review board statement: The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent statement: Zhongshan Hospital Institutional Review Board approved this retrospective study and waived the requirement for informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated or analyzed during the study are available from the corresponding author on reasonable request at liu.liheng@zs-hospital.sh.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Heng Liu, MD, Associate Chief Physician, Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200000, China. liu.liheng@zs-hospital.sh.cn
Received: March 30, 2025
Revised: April 16, 2025
Accepted: May 20, 2025
Published online: July 27, 2025
Processing time: 116 Days and 21.4 Hours
Abstract
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.

Keywords: Pancreatic ductal adenocarcinoma; Postoperative recurrence; Risk assessment system; Computed tomography; Model validation

Core Tip: This multinational study externally validated a preoperative computed tomography-based risk model, originally developed in South Korea, for predicting recurrence-free survival (RFS) in patients with pancreatic ductal adenocarcinoma (PDAC), after surgery. Analyzing 283 patients from a distinct population, the model-incorporating tumor size, portal venous phase density, necrosis, peripancreatic infiltration, and metastatic lymph nodes-stratified patients into prognostic groups. The good prognosis group exhibited significantly longer RFS despite a 76% overall recurrence rate. The findings confirm its cross-population applicability, supporting its use as a preoperative tool to identify patients at high risk of PDAC and guide clinical decision-making.