Frontiers in medicine · 2026
TNM stage I pancreatic ductal adenocarcinoma patients without pathological risk may drive limited benefit from adjuvant chemotherapy.
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Li Zhifei, Chen Xiaoxu, Liang Yuexiang, Bao Batu, Wang Xidong, Zhang Meng, Gao Chuntao
Аннотация
OBJECTIVE: In this study, we identified pathological risk factors as key determinants of whether patients with pancreatic ductal adenocarcinoma (PDAC) can benefit from adjuvant chemotherapy following radical resection.
METHODS: This single-center retrospective study enrolled 520 patients who underwent curative-intent resection for pancreatic ductal adenocarcinoma between 2011 and 2018. To minimize potential selection bias and confounding effects, propensity score matching (PSM) was performed using a 1:2 nearest-neighbor matching algorithm without replacement, with a caliper of 0.2 standard deviations of the logit propensity score. After matching, the patients were stratified based on the presence or absence of pathological risk factors, allowing for a comprehensive evaluation of how these factors influence the efficacy of adjuvant chemotherapy.
RESULTS: Based on the analysis for the whole study, the results showed that adjuvant chemotherapy could significantly improve the overall survival (OS) (p < 0.001) and recurrence-free survival (RFS) (p < 0.001). However, for patients in Tumor-Node-Metastasis (TNM) stage I without pathological risk factors, postoperative adjuvant chemotherapy did not significantly prolong the OS (median OS: NA vs.50.0 months, p = 0.365) and RFS (median RFS: 24 months vs.44 months, p = 0.569); for patients with pathological risk factors, adjuvant chemotherapy can significantly improve the OS (median OS: 28.0 months vs.17.0 months, p < 0.001) and RFS (median RFS: 21.0 months vs.7.0 months, p = 0.004).
CONCLUSION: The results of this study indicate that pathological risk factors play a key role in postoperative adjuvant chemotherapy for PDAC patients in TNM stage I. For patients in TNM stage I who harbored pathological risk factors, postoperative adjuvant chemotherapy was associated with a significant survival benefit. However, among those without pathological risk factors, no statistically significant association was observed between adjuvant chemotherapy and improved survival outcomes.
METHODS: This single-center retrospective study enrolled 520 patients who underwent curative-intent resection for pancreatic ductal adenocarcinoma between 2011 and 2018. To minimize potential selection bias and confounding effects, propensity score matching (PSM) was performed using a 1:2 nearest-neighbor matching algorithm without replacement, with a caliper of 0.2 standard deviations of the logit propensity score. After matching, the patients were stratified based on the presence or absence of pathological risk factors, allowing for a comprehensive evaluation of how these factors influence the efficacy of adjuvant chemotherapy.
RESULTS: Based on the analysis for the whole study, the results showed that adjuvant chemotherapy could significantly improve the overall survival (OS) (p < 0.001) and recurrence-free survival (RFS) (p < 0.001). However, for patients in Tumor-Node-Metastasis (TNM) stage I without pathological risk factors, postoperative adjuvant chemotherapy did not significantly prolong the OS (median OS: NA vs.50.0 months, p = 0.365) and RFS (median RFS: 24 months vs.44 months, p = 0.569); for patients with pathological risk factors, adjuvant chemotherapy can significantly improve the OS (median OS: 28.0 months vs.17.0 months, p < 0.001) and RFS (median RFS: 21.0 months vs.7.0 months, p = 0.004).
CONCLUSION: The results of this study indicate that pathological risk factors play a key role in postoperative adjuvant chemotherapy for PDAC patients in TNM stage I. For patients in TNM stage I who harbored pathological risk factors, postoperative adjuvant chemotherapy was associated with a significant survival benefit. However, among those without pathological risk factors, no statistically significant association was observed between adjuvant chemotherapy and improved survival outcomes.