Pancreatic ductal adenocarcinoma (PDAC) frequently exhibits an immunosuppressive microenvironment coupled with malnutrition status. These features are instrumental in clinical management strategies for PDAC. Immune-nutrition status of patients was evaluated by integrating systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI). Individuals were divided into SII-PNI Status positive (SPS+) group and SPS negative (SPS−) group. Morphology of tissues was evaluated by hematoxylin-eosin (H&E) staining. Expression of PD-L1 and p53 was detected using immunohistochemistry (IHC). In this study, 530 eligible patients (mean ± SD age, 60.5 ± 9.17 years, 296 males [55.8%], 74 SPS+ [14.0%]) were included. These patients exhibited a median survival of 24 months (1-, 3- and 5-year survival rate; 72.9%, 34.7% and 25.1%, respectively). In the multivariate analysis, independent indicators for outcomes were identified as tumor size, lymph node metastasis and SPS (all p <.01). After matching and adjusting, patients with SPS+ exhibited a notably reduced overall survival compared to those with SPS− (14 vs. 25 months, p <.001), with hazard ratio (95% CI) of 1.79 (1.25–2.56). IHC revealed markedly elevated positive cell proportion of PD-L1 in SPS+ group (p <.01) and distinct p53 mutation patterns between SPS+ and SPS− groups (p =.03). Morphology demonstrated a dissimilar trend of differentiation levels between the two groups (p =.08). The findings suggest poorer outcome, higher PD-L1 expression and distinct p53 mutation status of patients with SPS+. These patterns may contribute to PDAC management and strategic deployment of immunotherapy and targeted therapy.

Objectives: This study aims to assess the association between adjuvant radiotherapy and the development of second primary malignancies (SPMs) and identify its determinants in patients who have undergone surgical treatment for gastric cancer. Design: Retrospective cohort study using the Surveillance, Epidemiology and End Results (SEER) database. Setting: Cohorts (18 registries, 2000–2018, from SEER) were screened for any malignancy that developed after sufficient latency from diagnosis of surgically treated non-metastatic gastric cancer. Participants: 24 777 surgically treated gastric cancer cases were included in the cohort. Among them, 6128 patients underwent adjuvant radiotherapy. Outcome measures: The cumulative incidence of SPMs was estimated using Fine and Gray’s competing risk model and the radiotherapy-correlated risks were calculated using Poisson regression analysis. Results: Among patients with sufficient latency, there was no significant association between radiotherapy and the risk of developing second primary solid malignancies (relative risk=1.05, 95% CI 0.83 to 1.33) or haematological malignancies (relative risk=1.17, 95% CI 0.62 to 2.11). Interestingly, radiotherapy was associated with a reduced cumulative incidence of second lung and bronchus cancer compared with no radiotherapy, with a 15-year incidence of 1.4%–3.17% (p<0.05). Radiotherapy was not associated with a significant increase in standardised incidence ratios of SPMs. Conclusions: Adjuvant radiotherapy was not associated with an increased risk of developing SPMs in surgically treated patients with gastric cancer. Clinical trials are warranted to further verify the findings.

Background: The effectiveness of adjuvant chemotherapy (ACT) in ampullary adenocarcinoma (AA) patients and under what conditions ACT should be applied are not clearly defined.Methods: The study encompassed a series of consecutive AA patients who underwent curative surgical resection. These patients were sourced from the National Cancer Center of China, spanning the years 1998 to 2020, as well as from 12 registries within the Western surveillance, epidemiology, and end results program, covering the period from 2004 to 2017. The quantitative nodal burden was evaluated using the log odds of positive lymph nodes (LODDS). The correlation between ACT and overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS), was meticulously evaluated using Cox proportional hazards regression models and tested by interaction analysis.Results: Despite its rarity, a total of 948 and 225 eligible patients were included in the Western cohort and the China cohort, respectively. ACT was not significantly associated with improved long-term survival of unselected AA patients in both the China cohort (OS: P = 0.86, RFS: P = 0.84) and Western cohort (OS: P = 0.11, CSS: P = 0.82). After the quantitative analysis of nodal tumor burden, the study revealed that in patient subgroup with LODDS exceeding -1.4, significantly prolonged survival outcome emerged in patients received ACT (Surgery+ACT VS. Surgery alone, HR: 0.38, 95% CI: 0.19 - 0.75, P = 0.01). The multivariate analysis demonstrated that increasing LODDS was associated with increasing survival benefit from ACT (P for interaction = 0.03), whereas the N classification did not reliably identify patients benefiting from ACT based on statistical test of interaction (P = 0.20).Conclusion: This study emphasizes the potential of LODDS to inform personalized therapeutic decisions in the management of AA.