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Purpose <p>Symptom presentation at diagnosis is considered a surrogate marker of disease stage in pancreatic ductal adenocarcinoma (PDAC). However, its prognostic impact across resectability stages remains unclear. We evaluated whether symptoms serve as biological risk indicators using stratified analyses of surgical and non-surgical cohorts.</p> Methods <p>This retrospective single-center study included 729 patients with PDAC: non-resected (<i>n</i> = 519) and resected (<i>n</i> = 210), including 179 with anatomically resectable disease. Patients were classified as asymptomatic or symptomatic at the time of diagnosis. Overall survival (OS) was compared, and preoperative variables were assessed as independent predictors of OS.</p> Results <p>Symptomatic patients had a significantly worse overall survival (OS) across cohorts. In the non-resected cohort, the 3-year OS was 1.8% in symptomatic patients vs. 10.3% in asymptomatic patients (<i>p</i> &lt; 0.001). In the resected cohort, the 5-year OS was 27.6% vs. 38.7% (<i>p</i> = 0.024). In the resectable cohort, the 5-year OS was 22.5% vs. 38.3% (<i>p</i> &lt; 0.001). Symptom presentation independently predicted a poorer OS in multivariable analyses of resected patients (hazard ratio, 1.58; <i>p</i> = 0.024) and those with anatomically resectable disease (hazard ratio, 1.83; <i>p</i> = 0.015).</p> Conclusions <p>Symptoms at diagnosis were associated with a poorer OS in PDAC, regardless of resectability, suggesting a simple, broadly available marker that may complement anatomical stratification.</p>

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Symptom presentation at diagnosis as a biological risk indicator in both resectable and unresectable pancreatic ductal adenocarcinoma

  • 期刊论文

  • 发表日期：

    2026年7月27日

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  • Takahiro Tomino,
  • Keishi Sugimachi,
  • Lingaku Lee,
  • Takeshi Kurihara,
  • Emi Onishi,
  • Yusuke Niina,
  • Terumasa Hisano,
  • Rie Sugimoto,
  • Naomichi Koga,
  • Yuta Kasagi,
  • Masahiko Sugiyama,
  • Yasue Kimura,
  • Masaru Morita

摘要

Purpose

Symptom presentation at diagnosis is considered a surrogate marker of disease stage in pancreatic ductal adenocarcinoma (PDAC). However, its prognostic impact across resectability stages remains unclear. We evaluated whether symptoms serve as biological risk indicators using stratified analyses of surgical and non-surgical cohorts.

Methods

This retrospective single-center study included 729 patients with PDAC: non-resected (n = 519) and resected (n = 210), including 179 with anatomically resectable disease. Patients were classified as asymptomatic or symptomatic at the time of diagnosis. Overall survival (OS) was compared, and preoperative variables were assessed as independent predictors of OS.

Results

Symptomatic patients had a significantly worse overall survival (OS) across cohorts. In the non-resected cohort, the 3-year OS was 1.8% in symptomatic patients vs. 10.3% in asymptomatic patients (p < 0.001). In the resected cohort, the 5-year OS was 27.6% vs. 38.7% (p = 0.024). In the resectable cohort, the 5-year OS was 22.5% vs. 38.3% (p < 0.001). Symptom presentation independently predicted a poorer OS in multivariable analyses of resected patients (hazard ratio, 1.58; p = 0.024) and those with anatomically resectable disease (hazard ratio, 1.83; p = 0.015).

Conclusions

Symptoms at diagnosis were associated with a poorer OS in PDAC, regardless of resectability, suggesting a simple, broadly available marker that may complement anatomical stratification.