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Background <p>Postoperative recurrence severely limits long-term survival after radical resection for pancreatic ductal adenocarcinoma (PDAC), yet the spatiotemporal heterogeneity and determinants of recurrence remain incompletely understood.</p> Methods <p>We conducted a single-center retrospective study of PDAC patients who underwent radical surgery at our institution between 2014 and 2024. Regression analyses were used to identify factors associated with temporal (early [≤ 1&#xa0;year] vs. late [&gt; 1&#xa0;year] recurrence) and spatial (site of initial recurrence) heterogeneity.</p> Results <p>Among 1,065 enrolled patients, 879 experienced recurrences, with cumulative recurrence rates of 55.7, 76.6, and 92.3% at 1, 2, and 5&#xa0;years, respectively. Early recurrence occurred in 593 patients and late recurrence in 286. Initial recurrence patterns included local (22.4%), liver (52.3%), lung (5.8%), peritoneal (12.7%), and mixed/other metastases (6.7%). Male, poor tumor differentiation, advanced pathological stage, and lack of adjuvant therapy were independent factors for early recurrence. Liver and peritoneal metastases were independently associated with early recurrence and shorter recurrence-free survival (RFS), whereas lung metastasis correlated with later recurrence and longer RFS. Key factors influencing RFS varied by recurrence site: for local recurrence–poor differentiation, nodal metastasis, and no adjuvant therapy; for liver metastasis-larger tumor size, poor differentiation, nodal metastasis, and no adjuvant therapy; for lung metastasis-larger tumor size and nodal metastasis; for peritoneal metastasis-larger tumor size, surgical procedure, nodal metastasis, and no adjuvant therapy.</p> Conclusions <p>Postoperative recurrence in PDAC demonstrates significant spatiotemporal heterogeneity, with timing-specific and site-specific risk factors. These findings support tailored follow-up strategies and refined risk assessment for recurrent PDAC.</p> Graphical abstract <p></p>

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Spatiotemporal heterogeneity of recurrence and predictors after radical surgery for pancreatic ductal adenocarcinoma: a retrospective observational study

  • 期刊论文

  • 发表日期：

    2026年7月9日

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  • Rui Wang,
  • Tianrui Kuang,
  • You Long,
  • Yuanbin Huang,
  • Yunwei Sun,
  • Yugui Tian,
  • Junjie Ding,
  • Pan Gao,
  • He Cai,
  • Yongbin Li,
  • Xin Wang,
  • Yunqiang Cai,
  • Jin Zhou,
  • Bing Peng,
  • Zhong Wu

摘要

Background

Postoperative recurrence severely limits long-term survival after radical resection for pancreatic ductal adenocarcinoma (PDAC), yet the spatiotemporal heterogeneity and determinants of recurrence remain incompletely understood.

Methods

We conducted a single-center retrospective study of PDAC patients who underwent radical surgery at our institution between 2014 and 2024. Regression analyses were used to identify factors associated with temporal (early [≤ 1 year] vs. late [> 1 year] recurrence) and spatial (site of initial recurrence) heterogeneity.

Results

Among 1,065 enrolled patients, 879 experienced recurrences, with cumulative recurrence rates of 55.7, 76.6, and 92.3% at 1, 2, and 5 years, respectively. Early recurrence occurred in 593 patients and late recurrence in 286. Initial recurrence patterns included local (22.4%), liver (52.3%), lung (5.8%), peritoneal (12.7%), and mixed/other metastases (6.7%). Male, poor tumor differentiation, advanced pathological stage, and lack of adjuvant therapy were independent factors for early recurrence. Liver and peritoneal metastases were independently associated with early recurrence and shorter recurrence-free survival (RFS), whereas lung metastasis correlated with later recurrence and longer RFS. Key factors influencing RFS varied by recurrence site: for local recurrence–poor differentiation, nodal metastasis, and no adjuvant therapy; for liver metastasis-larger tumor size, poor differentiation, nodal metastasis, and no adjuvant therapy; for lung metastasis-larger tumor size and nodal metastasis; for peritoneal metastasis-larger tumor size, surgical procedure, nodal metastasis, and no adjuvant therapy.

Conclusions

Postoperative recurrence in PDAC demonstrates significant spatiotemporal heterogeneity, with timing-specific and site-specific risk factors. These findings support tailored follow-up strategies and refined risk assessment for recurrent PDAC.

Graphical abstract