Background/Objectives: Postoperative recurrence is a critical issue in the treatment of resectable pancreatic ductal adenocarcinoma (rPDAC). Moreover, the prognosis after early recurrence is extremely poor. This study aimed to develop a recurrence prediction model and to define early recurrence after upfront surgery (UFS) for rPDAC. Methods: This multicenter retrospective study included patients who underwent UFS for anatomically rPDAC between January 2013 and December 2017. Multivariate analyses were conducted to identify the risk factors for recurrence-free survival and to construct a recurrence prediction model. Subsequently, a minimum p value approach was used to determine the optimal cutoff values for early and late recurrence. Results: The cohort included 603 patients (325 men and 278 women). During the median follow-up period of 25 months (interquartile range, 15-38 months), 381 patients (63.2%) experienced a recurrence. Multivariate analyses revealed carbohydrate antigen 19-9 ≥37 U/mL (hazard ratio [HR], 1.58; p < 0.001), tumor size ≥ 2.2 cm (HR, 1.59; p < 0.001), lymph node metastasis (HR, 1.86; p < 0.001), R1 resection (HR, 1.56; p = 0.002), and no adjuvant chemotherapy (HR, 1.54; p < 0.001) as independent predictors. The recurrence prediction model demonstrated an area under the curve of 0.72-0.75. The optimal threshold for early and late recurrences was a recurrence-free interval of five months. Carbohydrate antigen 19-9 ≥ 156 U/mL was a significant predictor of early recurrence (OR, 3.28; p < 0.001). Conclusions: This study identified the prognostic risk factors for recurrence and developed a recurrence prediction model for patients undergoing UFS for rPDAC. Moreover, a recurrence-free interval of five months was identified as the optimal threshold for distinguishing between early and late recurrences.
Evidence regarding rectal cancer surgery in nonagenarians remains extremely limited because most previous studies combined colon and rectal cancers despite their distinct surgical complexity and functional implications. Rectal surgery in the oldest-old is particularly challenging because pelvic dissection, anastomotic complications, and permanent stoma formation may substantially affect perioperative risk and postoperative quality of life. As population aging progresses, clarifying the feasibility and oncologic validity of rectal cancer surgery in carefully selected nonagenarians has become increasingly important.
ABSTRACT Aim Surgical outcomes for colorectal cancer (CRC) in nonagenarians remain uncertain due to frailty, comorbidities, and malnutrition. The Geriatric Nutritional Risk Index (GNRI) is associated with surgical outcomes in older patients with CRC, but its prognostic value in nonagenarians is unclear. This study evaluated the GNRI's predictive value for short‐ and long‐term surgical outcomes in this population. Methods We retrospectively analyzed 225 nonagenarians undergoing surgical resection of CRC at 15 institutions between 2011 and 2022. Patients were stratified by GNRI‐high/low status using two cutoffs: 98 (Cohort 1) and 86 (Cohort 2). Outcomes included postoperative complications, length of hospital stay, and overall survival (OS). Stabilized inverse‐probability‐of‐treatment weighting (IPTW) was used to adjust for measured confounding. Results The median age was 92 years (female, 64.9%; colon cancer, 79.6%). GNRI‐high patients had higher body mass index and albumin levels. Complication rates did not differ between the groups. After adjustment, GNRI‐high patients in Cohort 1 had a shorter expected hospital stay (ratio 0.70, 95% CI 0.51–0.96; p = 0.025) but no significant OS difference. In Cohort 2, GNRI‐high patients had better OS ( p < 0.01), confirmed by adjusted Cox models (HR 0.54, 95% CI 0.35–0.82; p < 0.01). Conclusions Preoperative GNRI was associated with hospital stay and OS in nonagenarians undergoing CRC surgery, although the OS association was significant only with the cohort‐derived cutoff of 86, which requires external validation, and not with the literature‐based cutoff of 98. The GNRI is a simple tool to stratify surgical risk and optimize perioperative nutritional status in this vulnerable population.
PURPOSE:Peak systolic velocity ratios (PSVRs) measured by duplex ultrasound (DUS) are commonly used to evaluate arterial stenosis in patients with lower extremity artery disease. However, standardized measurement protocols have not yet been established. Although guidelines recommend setting the angle correction to 60° or as low as possible below 60°, the optimal angle correction for accurate PSVR measurement remains unclear. This study aimed to determine the appropriate angle correction values. The primary endpoint was the intraclass correlation coefficients (ICCs) for inter-observer and intra-observer agreement in PSVR measurements. RESULTS:The ICCs for inter-observer agreement for PSVR measurements were 0.65 (95% confidence interval = 0.32-0.75), 0.72 (0.40-0.79), and 0.74 (0.51-0.78), for angle correction values of 45°, 50°, and 60°, respectively. No significant differences were observed between the measurement methods. The ICCs for intra-observer agreement in PSVR measurements were 0.95 (95% confidence interval = 0.93-0.97), 0.97 (0.95-0.98), and 0.96 (0.95-0.97) when the angle correction values were set at 45°, 50°, and 60°, respectively. No significant differences were found between the measurement methods (P = .12 for 45° vs 50°, P = .41 for 50° vs 60°, and P = .59 for 60° vs 45°). CONCLUSION:No significant differences were noted among the 3 angle correction values. Therefore, an angle correction value of 45° to 60°, tailored to the specific clinical context, is considered reasonable.Clinical ImpactThe optimal angle correction for peak systolic velocity ratio (PSVR) measurement has not been clearly established. This prospective multicenter study demonstrates that angle correction values between 45° and 60° provide comparable inter- and intra-observer reproducibility. These findings suggest that strict adherence to a single angle correction value may not be necessary in clinical practice. Instead, selecting an angle close to the actual angle of incidence within this range may improve feasibility without compromising measurement reliability. These results provide practical guidance for standardizing PSVR assessment in routine vascular ultrasound examinations and clinical research.
