Preoperative Serum Total Cholesterol Predicts Adjuvant Chemotherapy Completion After Pancreaticoduodenectomy for Pancreatic Cancer.

BACKGROUND/AIM: Completion of adjuvant chemotherapy (AC) is a key determinant of long-term survival after curative-intent resection for pancreatic cancer. However, predictors of AC completion remain unclear. This study aimed to clarify the prognostic significance of AC non-completion and identify host-related factors after pancreaticoduodenectomy (PD).

PATIENTS AND

METHODS

We retrospectively analyzed 170 patients who were scheduled to receive AC after PD for pancreatic cancer. Associations between AC completion status and survival outcomes were evaluated. Independent predictors of AC non-completion were identified using logistic regression, and model performance was assessed through receiver operating characteristic analysis, calibration plots, and decision curve analysis (DCA).

RESULTS

Of the 170 patients, 116 (68.2%) completed standard AC (complete group), whereas 54 (31.8%) discontinued treatment (incomplete group). The 5-year survival rate was significantly lower in the incomplete group than in the complete group (16.7% vs. 45.3%, p<0.001). Low serum total cholesterol (T-chol) independently predicted poor AC tolerance. The T-chol model demonstrated moderate discrimination (area under the curve: 0.697) and good calibration. DCA indicated a favorable net clinical benefit for T-chol within a threshold probability range of 0.2-0.4.

CONCLUSION

Serum T-chol is a strong predictor of AC completion and may help identify patients with pancreatic cancer who could benefit from targeted nutritional or supportive interventions during the perioperative period.