Factors Associated With Recurrence After Adjuvant Gemcitabine and Nab‐Paclitaxel in Patients With Resected Pancreatic Ductal Adenocarcinoma
Tao Xia, Chi Cheng, Yudi Meng, Hao Huang, Duo Li, Renfan Zhu, Chengcong Qiu, Yongfei HuaABSTRACT
Background
Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis despite curative‐intent resection and adjuvant therapy. Gemcitabine plus nab‐paclitaxel (Gem‐NAP) has become a standard adjuvant regimen for PDAC, yet recurrence rates remain high. This study aimed to identify clinical and pathological factors associated with recurrence and survival in patients receiving adjuvant Gem‐NAP following PDAC resection.
Methods
We retrospectively identified 210 patients with resected PDAC who received adjuvant gemcitabine and nab‐paclitaxel at a single institution between May 2017 and October 2024. Clinicopathological characteristics, recurrence patterns, disease‐free survival (DFS), and overall survival (OS) were analyzed. Univariate and multivariate models were utilized to identify independent predictors of recurrence and survival.
Results
In total, 132 patients (62.9%) experienced recurrence, with a median DFS of 21.0 months (95% CI: 16.7–25.3) and a median OS of 39.0 months (95% CI: 32.7–45.3). Local recurrence (28.6%) and liver metastasis (24.8%) were the most common recurrence sites. Multivariable analysis revealed that preoperative CA19‐9 > 37 U/mL (OR: 2.28; 95% CI: 1.19–4.34; p = 0.01) and a lymph node ratio (LNR) > 0.14 (OR: 2.98; 95% CI: 1.19–7.47; p = 0.02) were significantly associated with recurrence. Independent predictors of worse DFS included elevated preoperative CA19‐9 (> 37 U/mL) (HR: 1.59; 95% CI: 1.04–2.43; p = 0.03), LNR > 0.14 (HR: 1.88; 95% CI: 1.23–2.89; p < 0.01), R1 resection (HR: 2.71; 95% CI: 1.36–5.38; p < 0.01), and lymphovascular invasion (LVI) (HR: 1.59; 95% CI: 1.09–2.30; p = 0.02). For OS, the independent predictors were R1 resection (HR: 3.00; 95% CI: 1.45–6.22; p < 0.01), LVI positivity (HR: 1.55; 95% CI: 1.03–2.34; p = 0.04), and LNR > 0.14 (HR: 1.76; 95% CI: 1.11–2.80; p = 0.02).
Conclusions
Recurrence after adjuvant gemcitabine and nab‐paclitaxel in patients with resected pancreatic cancer remains common. A high lymph node ratio, R1 resection, and lymphovascular invasion were powerful independent predictors of both poor DFS and OS.