{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:46:30Z","timestamp":1791863190745,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R50CA293523"],"award-info":[{"award-number":["1R50CA293523"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["K08 AR081391"],"award-info":[{"award-number":["K08 AR081391"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["T35DK126628"],"award-info":[{"award-number":["T35DK126628"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>To evaluate the prognostic significance of baseline and longitudinal changes in prognostic nutritional index (PNI) in localized pancreatic ductal adenocarcinoma (PDAC) and to assess the complementary prognostic value of PNI with tumor burden measured by circulating tumor DNA (ctDNA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed 127 patients with localized PDAC enrolled in a prospective biomarker study (2020\u20132024). Laboratory values were collected at five standardized timepoints. PNI was calculated as (10\u2009\u00d7\u2009albumin)\u2009+\u2009(0.005\u2009\u00d7\u2009lymphocyte count).\n                      <jats:italic>KRAS<\/jats:italic>\n                      ctDNA was assessed using digital droplet PCR. The primary endpoint was overall survival (OS), analyzed using Kaplan\u2013Meier and Cox regression, with longitudinal changes assessed using Friedman testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Low PNI (&lt;\u200945) at diagnosis was associated with worse OS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043). PNI declined significantly across treatment timepoints (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In multivariable analysis, decline in PNI during neoadjuvant chemotherapy independently predicted worse OS (HR 1.095, 95% CI 1.042\u20131.152,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Patients with both low PNI and ctDNA positivity had a 3.64\u2010fold increased risk of death (HR 3.64, 95% CI 1.32\u201310.04,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PNI is a dynamic, clinically accessible biomarker that independently predicts survival in localized PDAC. Integration of PNI with ctDNA improves prognostic stratification by capturing both patient host vulnerability and tumor burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70296","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T07:10:22Z","timestamp":1780384222000},"page":"272-281","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dynamic Prognostic Nutritional Index With Circulating Tumor DNA Predicts Survival in Localized Pancreatic Ductal Adenocarcinoma"],"prefix":"10.1002","volume":"134","author":[{"given":"Alex","family":"Horowitz","sequence":"first","affiliation":[{"name":"Department of Surgery Division of Surgical Oncology Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Surgical Oncology Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic J.","family":"Vitello","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Surgical Oncology Chicago Illinois USA"},{"name":"Northwestern Quality Improvement, Research &amp; Education in Surgery, Department of Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Cox","sequence":"additional","affiliation":[{"name":"Northwestern Medicine Cancer Centers Northwestern Medicine Regional Medical Group Winfield Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Wells","sequence":"additional","affiliation":[{"name":"Northwestern Medicine Cancer Centers Northwestern Medicine Regional Medical Group Winfield Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4754-8759","authenticated-orcid":false,"given":"Krishay","family":"Sridalla","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Surgical Oncology Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Bentrem","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Surgical Oncology Chicago Illinois USA"},{"name":"Northwestern Quality Improvement, Research &amp; Education in Surgery, Department of Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA"},{"name":"Northwestern Medicine Cancer Centers Northwestern Medicine Regional Medical Group Winfield Illinois USA"},{"name":"Robert H. Lurie Comprehensive Cancer Center of Northwestern University Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Robert H. Lurie Comprehensive Cancer Center of Northwestern University Chicago Illinois USA"},{"name":"Circulating Tumor Cell Core Facility Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishan","family":"Roy","sequence":"additional","affiliation":[{"name":"Robert H. Lurie Comprehensive Cancer Center of Northwestern University Chicago Illinois USA"},{"name":"Department of Physical Medicine &amp; Rehabilitation Northwestern University Feinberg School of Medicine Chicago Illinois USA"},{"name":"Shirley Ryan AbilityLab Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhil","family":"Chawla","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Surgical Oncology Chicago Illinois USA"},{"name":"Northwestern Quality Improvement, Research &amp; Education in Surgery, Department of Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA"},{"name":"Northwestern Medicine Cancer Centers Northwestern Medicine Regional Medical Group Winfield Illinois USA"},{"name":"Robert H. Lurie Comprehensive Cancer Center of Northwestern University Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-023-00746-1"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002234"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.00041"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminoncol.2018.12.002"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbcan.2020.188409"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2021.05.033"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006209"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006562"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13050994"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-67235-y"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/hvac153"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12032-012-0226-8"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.21873\/anticanres.16572"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature07205"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2012.08.003"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.4103\/sjg.SJG_390_18"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2021.08.003"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.992641"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.14701\/ahbps.2019.23.4.372"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-024-13244-z"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.1424"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16162911"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.76.8671"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/cas.16104"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2023.102007"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-020-00917-2"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.897033"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1021\/ac202028g"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12220"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70218-7"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12029-024-01129-0"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70296","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.70296","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70296","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:06:46Z","timestamp":1791860806000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/jso.70296"],"URL":"https:\/\/doi.org\/10.1002\/jso.70296","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"assertion":[{"value":"2026-03-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}