What question did this study set out to answer?

This study aims to create and validate risk scores using CT features and inflammatory markers to predict recurrence after surgery for pancreatic ductal adenocarcinoma.

July 3, 2026Open Access

Preoperative CT and inflammatory index–based risk scores for predicting short-term recurrence following resection of pancreatic ductal adenocarcinoma

MMMohammad Masih Mansouri‐TehraniIran University of Medical Sciences FZFarhad ZamaniIran University of Medical Sciences HIHamed IrajiIran University of Medical Sciences

Key Points

This study aims to create and validate risk scores using CT features and inflammatory markers to predict recurrence after surgery for pancreatic ductal adenocarcinoma.
Retrospective cohort of patients with resectable/borderline pancreatic ductal adenocarcinoma undergoing pancreaticoduodenectomy from 2017 to 2024.
Analyzed CT parameters and inflammatory indices using logistic regression for up-front surgery and neoadjuvant therapy groups.
Model performance assessed through area under the curve, calibration, and decision-curve analysis.
Of 544 resections, 133 patients met eligibility criteria (81 in up-front surgery and 52 in neoadjuvant therapy).
Models yielded AUC values of 0.84 (up-front surgery) and 0.81 (neoadjuvant therapy), outperforming AJCC 8ᵗʰ staging by ΔAUC +0.19 and +0.20.
Models included critical factors such as tumor size, necrosis, inflammatory ratios, and hepatic artery contact for better outcome predictions.

Abstract

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis, with nearly half of resected patients relapsing within one year. Current National Comprehensive Cancer Network (NCCN) and American Joint Committee on Cancer (AJCC) staging systems inadequately reflect tumor biology. This study aimed to develop and validate preoperative risk scores integrating computed tomography (CT) features and systemic inflammatory markers to predict 12-month recurrence. Methods In this two-center retrospective cohort, consecutive patients with histologically confirmed resectable/borderline PDAC who underwent pancreaticoduodenectomy (2017–2024) were included. Standardized preoperative multiphase CT and laboratory data within 28 days before surgery were reviewed. Quantitative and qualitative CT parameters and inflammatory indices were analyzed using multiple imputation and pathway-specific logistic regression for up-front surgery (US) and neoadjuvant therapy (NT) groups. Model performance was evaluated by discrimination, calibration, and decision-curve analysis. Results Of 544 resections, 133 met eligibility (US = 81; NT = 52). Final models retained tumor size, necrosis, fat stranding, and the C-reactive protein-to-albumin ratio (CAR) and neutrophil-to-lymphocyte ratio (NLR) for US, and tumor size, hepatic-artery contact ≥ 90°, CAR, NLR, and carcinoembryonic antigen (CEA) for NT. Development area under the curve (AUC) values were 0.84 (US) and 0.81 (NT), and test AUCs were 0.82 and 0.78, respectively, outperforming AJCC 8ᵗʰ staging (ΔAUC + 0.19 and + 0.20). Conclusions Compact, pathway-specific preoperative scores combining CT descriptors and inflammatory indices improved prediction of early recurrence compared with AJCC staging, supporting their potential use for individualized surgical and perioperative decision-making.

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