Factors Associated With Recurrence After Adjuvant Gemcitabine and Nab‐Paclitaxel in Patients With Resected Pancreatic Ductal Adenocarcinoma
- 1Department of Hepatobiliary and Pancreatic Surgery The Affiliated Lihuili Hospital of Ningbo University Ningbo China
Abstract
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.
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BibTeX
@article{xia2026factors,
title = {{Factors Associated With Recurrence After Adjuvant Gemcitabine and Nab‐Paclitaxel in Patients With Resected Pancreatic Ductal Adenocarcinoma}},
author = {Tao Xia and Chi Cheng and Yudi Meng and Hao Huang and Duo Li and Renfan Zhu and Chengcong Qiu and Yongfei Hua},
journal = {Cancer Medicine},
year = {2026},
month = nov,
doi = {10.1002/cam4.72491},
url = {https://doi.org/10.1002/cam4.72491},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Factors Associated With Recurrence After Adjuvant Gemcitabine and Nab‐Paclitaxel in Patients With Resected Pancreatic Ductal Adenocarcinoma
AU - Tao Xia
AU - Chi Cheng
AU - Yudi Meng
AU - Hao Huang
AU - Duo Li
AU - Renfan Zhu
AU - Chengcong Qiu
AU - Yongfei Hua
PY - 2026
DA - 2026/11/05
JO - Cancer Medicine
DO - 10.1002/cam4.72491
UR - https://doi.org/10.1002/cam4.72491
AB - 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.
SN - 2045-7634
ER -