{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:05:08Z","timestamp":1789538708615,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early recurrence after resection for pancreatic ductal adenocarcinoma (PDAC) remains common and is not fully captured by conventional clinicopathologic variables. This study evaluated whether dynamic perioperative CA19-9 and inflammatory-nutritional recovery patterns were associated with early recurrence and survival after curative-intent resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This real-world cohort study included patients with pathology-confirmed PDAC who underwent curative-intent R0\/R1 resection at The Third People's Hospital of Yunnan Province. Postoperative biomarker assessments were defined at postoperative days (PODs) 21\u201345 and 75\u2013105. A transparent three-level dynamic pattern integrated early CA19-9 behavior with 3-month NLR, CRP, and PNI recovery; 255 of 268 patients were classifiable. Because exposure ascertainment extended through POD 105, exposure-dependent analyses used a common POD-105 landmark. The primary outcome was recurrence within 12 months; secondary outcomes were recurrence-free survival (RFS) and overall survival (OS). Multivariable regression, 1,000-replicate bootstrap internal validation, and competing-risk sensitivity analysis were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 268 included patients, 78 (29.1%) experienced early recurrence, 149 (55.6%) developed recurrence during follow-up, and 130 (48.5%) died. In the primary dynamic-pattern cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009255), 94 patients (36.9%) were classified as favorable, 121 (47.5%) as intermediate, and 40 (15.7%) as poor; early recurrence occurred in 20.2%, 28.1%, and 50.0%, respectively. Compared with the favorable pattern, the adjusted odds ratios for early recurrence were 2.02 (95% CI, 1.01\u20134.02) for the intermediate pattern and 4.96 (95% CI, 2.10\u201311.71) for the poor pattern. The poor pattern was also associated with shorter RFS (adjusted HR, 2.12; 95% CI, 1.31\u20133.42) and OS (adjusted HR, 2.52; 95% CI, 1.50\u20134.24). The apparent AUC was 0.648 for the clinical model and 0.702 after adding the dynamic pattern (DeLong\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.057); corresponding optimism-corrected AUCs were 0.605 and 0.661.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A poor postoperative dynamic recovery pattern was consistently associated with higher early-recurrence risk and shorter RFS and OS after PDAC resection. The dynamic pattern provided modest incremental discriminative information beyond clinicopathologic variables, but performance remained moderate after internal validation. External validation is required before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1899908","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:34:37Z","timestamp":1789536877000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dynamic perioperative CA19-9 and inflammatory-nutritional recovery patterns are associated with early recurrence and survival after resection for pancreatic ductal adenocarcinoma: a real-world cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Chengyu","family":"Wang","sequence":"first","affiliation":[{"name":"Department of General Surgery, The Third People\u2019s Hospital of Yunnan Province","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoping","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Third People\u2019s Hospital of Yunnan Province","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anju","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Third People\u2019s Hospital of Yunnan Province","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Third People\u2019s Hospital of Yunnan Province","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Third People\u2019s Hospital of Yunnan Province","place":["Kunming, 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