# Clinical outcomes and recurrence patterns in pancreatic ductal adenocarcinoma diagnosed at an early stage: insights from a multicenter cohort study in Japan

## TL;DR

Early-stage pancreatic cancer patients have higher risks of recurrence in the remaining pancreas, highlighting the need for long-term monitoring.

## Contribution

Identifies early-stage PDAC as a higher risk for remnant pancreatic recurrence compared to stage II disease.

## Key findings

- Stage 0 and I PDAC patients had higher remnant pancreatic recurrence rates than stage II patients.
- Pathological stage 0–I and long follow-up (>5 years) were independent risk factors for recurrence.
- 5-year survival rates decreased with increasing PDAC stage (87% for stage 0 to 49% for stage II).

## Abstract

The prognosis and recurrence patterns of early-diagnosed pancreatic ductal adenocarcinoma (PDAC), particularly following surgical resection, remain unclear.

This multicenter retrospective study analyzed patients who underwent surgical resection for PDAC between 2005 and 2023. Patients were categorized according to pathological stages 0, I, and II. Recurrence patterns and survival outcomes were compared among the three groups. Multivariate analysis was performed to identify independent risk factors for remnant pancreatic recurrence, including early-stage disease, postoperative follow-up of more than 5 years, and receipt of adjuvant chemotherapy.

A total of 349 patients were included: 51 with stage 0, 77 with stage I, and 221 with stage II PDAC. The 5-year overall survival rates were 87%, 71%, and 49% for patients with stage 0, I, and II PDAC, respectively. Remnant pancreatic recurrence was observed in 10% of patients with stage 0 PDAC and 18% of patients with stage I PDAC, compared with 5% of those with stage II PDAC. Recurrence was significantly more frequent in stage I (P < 0.001) and tended to be higher in stage 0 (P = 0.062) than in stage II. Multivariate analysis identified pathological stage 0–I and postoperative follow-up of > 5 years as independent risk factors for remnant pancreatic recurrence.

Patients with early-stage PDAC exhibit a higher risk of remnant pancreatic recurrence than those with stage II disease. These findings underscore the importance of long-term pancreas-focused surveillance in early-stage PDAC to enable timely detection of late recurrence and potentially improve patients outcomes.

The online version contains supplementary material available at 10.1007/s00535-025-02340-x.