{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T16:06:34Z","timestamp":1789401994813,"version":"build-2803163510"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"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>Objective<\/jats:title>\n                    <jats:p>In this study, we identified pathological risk factors as key determinants of whether patients with pancreatic ductal adenocarcinoma (PDAC) can benefit from adjuvant chemotherapy following radical resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective study enrolled 520 patients who underwent curative-intent resection for pancreatic ductal adenocarcinoma between 2011 and 2018. To minimize potential selection bias and confounding effects, propensity score matching (PSM) was performed using a 1:2 nearest-neighbor matching algorithm without replacement, with a caliper of 0.2 standard deviations of the logit propensity score. After matching, the patients were stratified based on the presence or absence of pathological risk factors, allowing for a comprehensive evaluation of how these factors influence the efficacy of adjuvant chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Based on the analysis for the whole study, the results showed that adjuvant chemotherapy could significantly improve the overall survival (OS) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and recurrence-free survival (RFS) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). However, for patients in Tumor-Node-Metastasis (TNM) stage I without pathological risk factors, postoperative adjuvant chemotherapy did not significantly prolong the OS (median OS: NA vs.50.0 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.365) and RFS (median RFS: 24 months vs.44 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.569); for patients with pathological risk factors, adjuvant chemotherapy can significantly improve the OS (median OS: 28.0 months vs.17.0 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and RFS (median RFS: 21.0 months vs.7.0 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The results of this study indicate that pathological risk factors play a key role in postoperative adjuvant chemotherapy for PDAC patients in TNM stage I. For patients in TNM stage I who harbored pathological risk factors, postoperative adjuvant chemotherapy was associated with a significant survival benefit. However, among those without pathological risk factors, no statistically significant association was observed between adjuvant chemotherapy and improved survival outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1914610","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:40:02Z","timestamp":1789400402000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["TNM stage I pancreatic ductal adenocarcinoma patients without pathological risk may drive limited benefit from adjuvant chemotherapy"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhifei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary-Pancreatic-Splenic Surgery, Inner Mongolia Autonomous Region People\u2019s Hospital","place":["Hohhot, 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Mongolia Autonomous Region People\u2019s Hospital","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xidong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary-Pancreatic-Splenic Surgery, Inner Mongolia Autonomous Region People\u2019s Hospital","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary-Pancreatic-Splenic Surgery, Inner Mongolia Autonomous Region People\u2019s Hospital","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuntao","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Pancreatic Cancer, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin\u2019s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & 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