Hironobu Suto

Background Despite a strong association between nutritional indices and disease prognosis, evidence regarding the evaluation of nutritional indices after preoperative treatment for pancreatic ductal adenocarcinoma (PDAC) is insufficient. We evaluated the clinical significance of the prognostic nutritional index (PNI) in patients with resectable (R‐) and borderline resectable (BR‐) PDAC who received neoadjuvant chemoradiotherapy (NACRT) followed by pancreatic resection. Methods We assessed 153 patients with R‐ and BR‐PDAC who underwent NACRT followed by curative resection between 2009 and 2022. We evaluated the association between preoperative PNI after NACRT and short‐ and long‐term outcomes. Results The median preoperative PNI value after NACRT was 42.1, and the optimal cutoff value from the time‐dependent receiver operating characteristic curve was 38.6. The low PNI group (PNI < 38.6, n = 44) exhibited significantly worse inflammatory parameters, surgical outcomes, and prognoses than the high PNI group (PNI ≥ 38.6, n = 109). Multivariate analysis identified preoperative PNI ≤ 38.6 (hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.00–5.38, p = .049), blood loss ≥1642 mL (HR: 3.05, 95% CI: 1.65–5.64, p < .001), node positive pathology (HR: 2.10, 95% CI: 1.32–3.34, p = .002), and lack of postoperative adjuvant chemotherapy (HR: 3.55, 95% CI: 2.05–6.15, p < .001) as significant predictors of overall survival. Conclusions For patients with R‐ and BR‐PDAC receiving preoperative treatment, it is imperative to closely monitor their nutritional status when determining the optimal surgical procedure timing.

Purpose KRAS , P16 , TP53 , and SMAD4/DPC4 mutations are common in pancreatic ductal adenocarcinoma (PDAC). The study aimed to evaluate the association between gene mutations in pre‐treatment endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) samples and clinical outcomes of patients with PDAC. Methods There were 43 patients with resectable (R) PDAC and 41 patients with borderline resectable (BR) PDAC. CDKN2A/p16 , TP53 , and SMAD4/DPC4 were evaluated through immunohistochemistry (IHC) of pretreatment EUS‐FNA ( n = 84) and resected specimens ( n = 71). All patients received neoadjuvant therapy. Results IHC of EUS‐FNA specimens revealed p16 loss in 61 (73%), abnormal p53 in 61 (73%), and Smad4 loss in 38 (45%) patients. Abnormal p53 was associated with a lower resection rate ( p = .017). Abnormal p53 and Smad4 loss were associated with recurrence within 6 months post‐pancreatectomy ( p = .03, p = .03, respectively). Univariate Cox regression analysis was conducted to reveal that abnormal p53 ( p = .07), p16 loss and abnormal p53 ( p = .04), and Smad4 and p16 loss ( p = .03) were associated with poor prognosis. Conclusions Pre‐treatment abnormal labeling of p53 in EUS‐FNA specimen was associated with a lower resection rate and an early recurrence in R or BR PDAC cases.