Low prealbumin predicts early recurrence after pancreatic cancer surgery: a retrospective cohort study.

BACKGROUND: Early recurrence after curative resection for pancreatic ductal adenocarcinoma (PDAC) is linked to poor survival, but the prognostic role of host nutritional status is uncertain. We sought to identify independent predictors of early recurrence after surgery. METHODS: Fifty-seven patients who underwent pancreaticoduodenectomy or radical antegrade modular pancreaticosplenectomy for PDAC between March 2021 and December 2023 were retrospectively reviewed. Early recurrence was defined as recurrence within 1 year after surgery, whereas the non-early recurrence group included patients with recurrence after 1 year and those without recurrence during follow-up. Clinicopathologic and nutritional variables were analyzed using univariable and multivariable Cox proportional hazards models. Clinical differences between early-recurrence and non-early-recurrence groups were also assessed. RESULTS: In the univariable analysis, N2 stage [hazard ratio (HR) 3.43, P=0.03], resection margin <1 mm 
(HR 2.78, P=0.02), and prealbumin <20 mg/dL (HR 3.31, P=0.02) were significantly associated with early recurrence. In multivariable analysis, low prealbumin remained independently associated with early recurrence (HR 4.82, P=0.005). Group comparison further demonstrated higher frequencies of margin <1 mm (55.0% vs. 21.6%, P=0.01) and prealbumin <20 mg/dL (68.4% vs. 31.3%, P=0.01) in the early recurrence group. Other variables were not significantly different. CONCLUSIONS: Low preoperative prealbumin level remained consistently associated with early recurrence after curative PDAC resection. Margin status and nodal burden were associated with recurrence but lacked independent significance. Incorporating nutritional assessment into perioperative management may improve risk stratification and guide personalized postoperative surveillance.