Background: Pancreatic cancer is a highly aggressive malignancy with a poor prognosis. Neoadjuvant chemotherapy (NAC) is increasingly used to improve survival in patients with pancreatic cancer; however, it often results in nutritional deterioration, which may negatively impact patient outcomes. Therefore, this study aimed to assess the effect of changes in nutritional status on the long-term outcomes of patients with pancreatic cancer who underwent curative surgery after NAC. Methods: This retrospective single-center study included 148 patients with pancreatic cancer who underwent curative surgery after NAC between 2010 and 2020. The Controlled Nutritional Status (CONUT) score was used to determine the nutritional status of the patients. Patients were categorized into worsened, maintained, and improved groups based on the changes in their CONUT scores before and after NAC. We compared differences in overall survival (OS) and disease-free survival (DFS) between the groups. Results: The worsened nutritional status group exhibited the shortest median OS (28 months) compared to the maintained and improved groups (39 and 66 months, respectively; p = 0.01). Additionally, the worsened group demonstrated the shortest DFS compared to the other two groups (13, 22, and 39 months, respectively; p = 0.02). Multivariate analysis identified nutritional deterioration as an independent prognostic factor for OS (hazard ratios (HR), 2.11; 95% confidence intervals (CI), 1.31–3.40; p < 0.01). Conclusions: Nutritional deterioration after NAC is a significant prognostic factor of poor survival outcomes in patients with pancreatic cancer. These findings indicate that serial nutritional assessments and treatment during NAC are crucial for improving patient outcomes.

Background: Recent studies addressing the role of adjuvant chemotherapy (AC) in cholangiocarcinoma (CCA) have been published; however, there are challenges in generalizing the findings due to different prognostic characteristics depending on tumor location and resectability. Therefore, this study aimed to investigate the role of AC in distal cholangiocarcinoma (dCCA), a common tumor subtype of CCA.Method: Data from 497 patients with dCCA who underwent curative surgery at Seoul National University Hospital between 2000 and 2019 were reviewed using prospectively collected clinicopathologic information.Results: The median overall survival (OS) and recurrence‐free survival (RFS) in the entire cohort were 62.9 and 44.0 months, respectively. AC was associated with improved five‐year OS (58.5% vs. 46.4%; p < 0.001) and RFS (49.9% vs. 40.7%; p = 0.005), particularly in patients with advanced T stages (≥ T3). Multivariate analysis revealed that AC was an independent positive prognostic factor for survival. Furthermore, adjuvant radiotherapy (RT) alone provides no survival benefit, whereas AC combined with RT (AC + RT) offers greater benefits, particularly for patients with positive resection margins.Conclusion: AC improved the postoperative survival outcomes of patients with dCCA who underwent curative surgery. Furthermore, AC + RT appears to provide greater benefits, especially for patients with positive resection margins.

Although World Health Organization (WHO) grade 1 and 2 pancreatic neuroendocrine tumors (pNETs) are generally regarded as indolent, substantial biological heterogeneity exists, particularly within grade 2 (G2) tumors. This study evaluated whether subdividing G2 pNETs using new Ki-67 threshold improves postoperative risk stratification following curative resection. We retrospectively analyzed consecutive adults who underwent pancreatectomy for pNETs between 2010 and 2022. Tumors were classified as G1 (<3%), G2a (3-<10%), G2b (10-<20%), and G3 (≥20%). Outcomes were disease-free survival (DFS) and overall survival (OS) assessed through December 31, 2024. Multivariable Cox models identified independent predictors of DFS and OS. Among 300 patients (mean tumor size 2.65 ± 1.90 cm), grade distribution was 65.3%, 26.3%, 6.0%, and 2.3% for G1, G2a, G2b, and G3, respectively. DFS declined stepwise across grades (p < 0.001), with 5-year DFS of 88.1%, 68.9%, 45.5%, and 21.4%, respectively. OS also differed by grade (p < 0.001). On multivariable analysis, T stage >2, lymph node positivity, mitotic count >2, and grade subtype were independently associated with worse DFS, while grade subtype remained the only independent predictor of OS. Subclassification of WHO G2 pNETs using a 10% Ki-67 threshold enhances postoperative risk stratification. When integrated with established pathological factors, this approach may better identify patients at increased risk of recurrence following curative resection.

Choi GW, et al. Yonsei Med J. 2026 Jun;67(6):484-491. https://doi.org/10.3349/ymj.2025.0210