Beyond early detection: how health checkups independently contribute to pancreatic cancer survival outcomes

Beyond early detection: how health checkups independently contribute to pancreatic cancer survival outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Beyond early detection: how health checkups independently contribute to pancreatic cancer survival outcomes Minoru Fujita, Noriaki Manabe, Tomoari Kamada, Tomohiro Tanikawa, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9100031/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Although early detection of pancreatic ductal adenocarcinoma (PDAC) remains challenging, health checkups may improve clinical outcomes. This retrospective study compared the clinical characteristics of PDAC cases identified during health checkups (HC cohort, 61 patients) with those diagnosed through other methods (non-HC cohort, 801 patients). Transabdominal ultrasonography was more frequently utilized in the HC cohort ( P < 0.01). Patients in the HC cohort were significantly younger ( P < 0.05), with lower CEA and CA19-9 levels and smaller tumor sizes ( P < 0.01). Notably, the HC cohort showed significantly higher proportions of stage IA and stage IIA disease and higher rates of curative surgical resection (all P < 0.01). Overall survival in the HC cohort was significantly higher than in the non-HC cohort ( P < 0.01 for log-rank test and multivariable analysis), and tumor size ≤ 20 mm was significantly associated with survival exceeding 5 years in the HC cohort ( P = 0.015). Our findings suggest that health checkups facilitate earlier diagnosis of PDAC and improve long-term prognosis. Establishing a standardized screening system using transabdominal ultrasonography, specifically optimized to detect tumors ≤ 20 mm, is essential to improving survival in patients with PDAC. Health checkup overall survival pancreatic ductal adenocarcinoma transabdominal ultrasonography tumor size Figures Figure 1 Figure 2 Figure 3 Introduction Japan has a unique health checkup system for early disease detection that has been developed over many years. The primary purpose of this system is to promote health through early detection of cancer and lifestyle-related diseases and to conduct regular health assessments. Basic examinations include physical measurements; blood tests (e.g., complete blood count, liver and renal function tests, and lipid metabolism); urine analysis; fecal occult blood test; chest X-ray; upper gastrointestinal X-ray or endoscopy; transabdominal ultrasonography (US); and gynecological examination. The examinee is responsible for the cost of such examinations. However, the Japanese health checkup system is considered a key factor in the longevity of its citizens, contributing to reduced overall health care expenditures through early detection and treatment 1 . According to cancer statistics reported by the National Cancer Center Research Institute in Japan, pancreatic ductal adenocarcinoma (PDAC) is a highly lethal disease, for which mortality closely parallels incidence. A crude incidence rate of 36.5% per 100,000 population was observed in 2021, and a crude mortality rate of 34.3% per 100,000 population in 2024. Additionally, the crude mortality rate per 100,000 population has gradually increased, from 25.4% in 2015 to 34.3% in 2024 2 . Although PDAC is known to have a favorable prognosis when detected early (stage 0) or when smaller than 10 mm (Tumor Size 1a), it is often diagnosed at an advanced stage 3,4. The reasons for this include the absence of biomarkers for early-stage PDAC, its anatomical location in the retroperitoneum, which allows invasion of surrounding organs and blood vessels, and its non-specific symptoms 5 , 6 . Furthermore, most patients with PDAC remain asymptomatic until the disease reaches an advanced stage 7 – 9 . For earlier detection of PDAC, previous reports have demonstrated the usefulness of various modalities, such as transabdominal US, abdominal computed tomography (CT), abdominal magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) 9 – 17 . However, the selection of examination methods for PDAC screening in Japan varies among institutions and is not standardized 9 . While it has been reported that asymptomatic PDAC cases exhibit a more favorable prognosis than symptomatic cases 8 , little research has examined the clinical differences between PDAC cases diagnosed during health checkups and those diagnosed at another time. To efficiently detect PDAC earlier in asymptomatic individuals, it is crucial to understand the clinical characteristics and prognosis of PDAC cases diagnosed during health checkups. In this study, we aimed to clarify the clinical characteristics of patients with PDAC and evaluate the effectiveness of cancer screening processes during health checkups. Results Study 1: Comparisons between the HC and non-HC cohorts Of the enrolled patients, 61 (7.1%) were in the health checkup cohort (HC cohort), and 801 (92.9%) were in the non-health checkup cohort (non-HC cohort). Demographic data for the HC and non-HC cohorts are presented in Table 1 . The non-HC cohort had a significantly older mean age than the HC cohort ( P = 0.020). The proportion of patients with hyperlipidemia was markedly higher in the HC cohort than in the non-HC cohort ( P = 0.021). In contrast, the proportion of patients with cardiovascular disease was significantly higher in the non-HC cohort than in the HC cohort ( P = 0.036). No significant difference in the proportion of patients with a family history of malignancy, including PDAC, was observed between the HC and non-HC cohorts. CEA and CA19-9 levels were markedly higher in the non-HC cohort than in the HC cohort (both P < 0.001). Table 1 Demographic data for the HC and non-HC cohorts Mean age ± SD (years) HC cohort (n = 61) non-HC cohort (n = 801) P value 71.8 ± 7.2 74.2 ± 10.3 0.020 Male, n (%) 35 (57.3) 416 (51.9) 0.412 Smoking habit, n (%) 24 (39.3) 332 (41.4) 0.748 Drinking habit, n (%) 18 (29.5) 217 (27.1) 0.683 Body mass index, mean ± SD (kg/m 2 ) 21.3 ± 3.4 20.9 ± 3.7 0.295 Comorbidities and past histories, n (%) Hypertension 24 (39.3) 316 (39.5) 0.987 Diabetes mellitus 18 (29.5) 235 (29.3) 0.978 Hyperlipidemia 18 (29.5) 141 (17.6) 0.021 Cardiovascular disease 3 (4.9) 116 (14.5) 0.037 Cerebrovascular disease 3 (4.9) 90 (11.2) 0.125 Malignant tumor 14 (23.0) 167 (20.8) 0.698 Non 10 (16.4) 129 (16.1) 0.953 Family history, n (%) Malignancy* 21 (34.4) 218 (27.2) 0.225 PDAC 4 (6.6) 55 (6.8) 0.927 Blood test results# Glycated hemoglobin (%), mean ± SD 6.5 ± 1.1 6.8 ± 1.7 0.084 CEA (ng/mL), median (IQR) 3.5 (1.8–5.4) 4.8 (2.8–10.4) < 0.001 CA19-9 (U/mL), median (IQR) 93.3 (13.0–358.4) 285.1 (42.9–2744.4) < 0.001 Note: Bold values indicate P < 0.05; *, including PDAC; #, value at the time of PDAC diagnosis. Abbreviations: CA19-9, carbohydrate antigen 19 − 9; CEA, carcinoembryonic antigen; HC cohort, health checkup cohort; IQR, interquartile range; non-HC cohort, non-health checkup cohort; PDAC, pancreatic ductal adenocarcinoma; SD, standard deviation. The comparison of the trigger imaging examination for PDAC diagnosis is shown in Fig. 2 . Transabdominal US was significantly more common in the HC cohort compared with the non-HC cohort ( P < 0.001). The PDAC characteristic comparisons between the HC and non-HC cohorts are presented in Table 2 . No significant difference in tumor location was found between the HC and non-HC cohorts. Tumor size was significantly larger in the non-HC cohort than in the HC cohort ( P = 0.007). There was no significant difference in the number of patients with main pancreatic duct dilatation (≥ 3 mm) between the two cohorts. For PDAC staging, stage IA ( P < 0.001) and IIA ( P = 0.002) disease were significantly more frequent in the HC cohort than in the non-HC cohort. In contrast, stage IV PDAC was markedly more frequent in the non-HC cohort compared with the HC cohort ( P < 0.001). In the HC cohort, curative surgical resection alone ( P = 0.009) and curative surgical resection with neoadjuvant and/or adjuvant chemoradiotherapy ( P < 0.001) were significantly more frequent. In contrast, patients receiving only palliative care were more frequent in the non-HC cohort than in the HC cohort ( P < 0.001). Table 2 PDAC characteristic comparisons between the HC and non-HC cohorts Tumor location, n (%) HC cohort (n = 61) non-HC cohort (n = 801) P value Head 31 (50.8) 445 (55.6) 0.474 Body 15 (24.6) 151 (18.9) 0.273 Tail 15 (24.6) 205 (25.6) 0.863 Imaging findings, n (%) Tumor size, mean ± SD 26.4 ± 13.7 31.5 ± 14.2 0.007 Main pancreatic duct dilatation ≥ 3 mm, n (%) 45 (73.8) 562 (70.2) 0.554 Coexistence of intraductal papillary mucinous neoplasm, n (%) 10 (16.4) 76 (9.5) 0.083 Cancer stage, n (%) Stage 0 1 (1.6) 2 (0.2) 0.076 Stage IA 11 (18.0) 22 (2.4) < 0.001 Stage IB 0 (0.0) 12 (1.5) 0.336 Stage IIA 17 (27.9) 130 (16.2) 0.020 Stage IIB 10 (16.4) 94 (11.7) 0.282 Stage III 10 (16.4) 153 (19.1) 0.603 Stage IV 12 (19.7) 388 (48.4) < 0.001 Treatments, n (%) Curative surgical resection alone 6 (9.8) 26 (3.2) 0.007 Neoadjuvant and/or adjuvant chemoradiotherapy + curative surgical resection 27 (44.3) 128 (15.9) < 0.001 Chemoradiotherapy 27 (44.3) 380 (47.2) 0.632 Palliative care alone 1 (1.6) 271 (33.6) < 0.001 Note: Bold values indicate P < 0.05. Abbreviations: HC cohort, health checkup cohort; non-HC cohort, non-health checkup cohort; PDAC, pancreatic ductal adenocarcinoma; SD, standard deviation. Patient overall survival from the date of PDAC diagnosis was compared between the HC and non-HC cohorts using Kaplan-Meier survival analysis, as shown in Fig. 3 . The survival curves indicate that the health checkup was significantly associated with a longer survival time after PDAC diagnosis ( P < 0.001 for the log-rank test). The 5-year survival rates for the HC and non-HC cohorts were 35.9% and 10.5%, respectively. The median survival times for the HC and non-HC cohorts were 3.9 years and 0.9 years, respectively. In multivariable analysis, male sex, tumor location in the pancreatic head, tumor size ≤ 20 mm, cancer stage IIB–IV, curative surgical resection, and health checkups were significantly associated with overall survival (Table 3 ). Table 3 Univariable and multivariable analyses of factors associated with overall survival. Univariable analysis Multivariable analysis HR (95% CI) P value HR (95% CI) P value Age (years) < 65 1 ≥ 65 1.139 (0.938–1.384) 0.189 Sex Female 1 1 Male 1.234 (1.058–1.439) 0.006 1.275 (1.093–1.489) 0.002 Body mass index (kg/m 2 ) 20 1 1 ≤ 20 0.491 (0.407–0.592) < 0.001 0.643 (0.530–0.780) < 0.001 Cancer stage 0–IIA 1 1 IIB–IV 3.297 (2.615–4.157) < 0.001 2.457 (1.927–3.133) < 0.001 Treatment Chemoradiotherapy and/or palliative care 1 1 Curative surgical resection* 0.300 (0.239–0.378) < 0.001 0.334 (0.164–0.683) 0.003 Neoadjuvant therapy No 1 Yes 1.019 (0.682–1.523) 0.927 Adjuvant therapy No 1 Yes 0.466 (0.216–1.009) 0.053 Health checkups No 1 1 Yes 0.350 (0.243–0.502) < 0.001 0.424 (0.294–0.610) < 0.001 Note: Bold values indicate P < 0.05; *, including those in which neoadjuvant and/or adjuvant therapy was administered in addition to surgical resection. Abbreviations: CI, confidence interval; HR, Hazard ratio. Study 2: Associations between long-term survival after PDAC diagnosis and various factors in the HC cohort Next, we analyzed associations among patients who survived more than 5 years after PDAC diagnosis and various factors in the HC cohort. Multivariable analysis showed that tumor size ≤ 20 mm was significantly associated with survival beyond 5 years after diagnosis in the HC cohort (adjusted OR, 6.667; 95% CI, 1.448–30.747; P = 0.015; Supplemental Table 1). Discussion In this study, we analyzed the clinical characteristics of PDAC cases identified during health checkups (HC cohort) compared with those diagnosed through methods other than health checkups (non-HC cohort). The non-HC cohort had a significantly older mean age than the HC cohort. CEA and CA19-9 levels were markedly lower in the HC cohort than in the non-HC cohort. Consistent with the tumor marker level results, the HC cohort individuals were diagnosed at an earlier stage, with a higher proportion of patients undergoing curative surgical resections compared with the non-HC cohort. Moreover, the 5-year survival rate of the HC cohort was 35.9%, while that of the non-HC cohort was 10.3%, and multivariable analysis identified male sex, tumor location in the pancreatic head, tumor size ≤ 20 mm, cancer stage IIB–IV, curative surgical resection, and health checkup as significant predictors of overall survival. Given that the global 5-year survival rate for PDAC is less than 12% 18 , our results suggest that cancer screening during health checkups contributes to early detection and treatment, leading to long-term survival after PDAC diagnosis. In Europe and the United States, routine screening with abdominal MRI or EUS is recommended for individuals with a strong family history and/or a high genetic risk of PDAC, such as BRCA1/2 , LKB1/STK11 , or CDKN2A mutation. Conversely, screening for asymptomatic individuals at average risk is not recommended due to the low incidence of the disease 18 – 20 . However, only 25% of PDAC patients with stage 0 or stage I disease experience any symptoms, indicating the importance of surveillance in asymptomatic patients 9 . Additionally, previous work has shown that PDAC detected asymptomatically had a significantly smaller tumor size, earlier stage, higher tumor resection rate, and longer 5-year survival rate than symptomatic PDAC 8 . Therefore, diagnosing PDAC early, before any symptoms appear, contributes to early treatment and long-term survival for patients 9 , 10 . This study also revealed that the proportion of patients for whom transabdominal US was the method leading to PDAC diagnosis was markedly higher in the HC cohort compared with the non-HC cohort. Although various modalities are used for PDAC, abdominal CT highly relies on ionizing radiation, and abdominal MRI takes 20 to 30 minutes to produce the image. Additionally, if the patient has metal implants in their body, then MRI examination becomes more challenging to perform. FDG-PET leads to a high radiation dose and is costly overall 21 – 23 . EUS is most useful in detecting PDAC tumors less than 10 mm compared with the other modalities 11 . However, the EUS procedure poses a higher risk of gastrointestinal perforation relative to regular gastroscopy examination. Because EUS scopes for pancreato-biliary diseases place the ultrasound transducer positioned in front of the optical lens, the length and diameter of the scope are increased. As a result, the flexibility and maneuverability of the EUS scope are limited 24 . Therefore, it is challenging to frequently perform EUS, causing this approach to be unsuitable for PDAC screening of asymptomatic participants during health checkups. In contrast, transabdominal US is a non-invasive and cost-effective technique, making it a preferred modality for PDAC screening of asymptomatic individuals 16 . Takikawa et al. 8 reported that transabdominal US was the most commonly used imaging modality to detect PDAC in asymptomatic participants during health checkups. However, this approach has some limitations. The diagnostic accuracy of transabdominal US for PDAC depends on the skill of the operator and the condition of the patient, such as their physique, age, daily living activities, comorbidities, and the presence and amount of interfering intestinal gas. Our study revealed that tumor location in the pancreatic head and tumor size ≤ 20 mm were significantly associated with overall survival in patients with PDAC. Patients with PDAC of the pancreatic head often present with obstructive jaundice, whereas those with PDAC in the body or tail tend to exhibit nonspecific symptoms, such as abdominal pain and weight loss. Consequently, PDAC of the pancreatic head is typically detected at an earlier stage, leading to relatively better survival rates 25 . Transabdominal US often fails to visualize the entire pancreas. Therefore, identifying small tumors in the pancreatic body or tail can be difficult 16 , 17 . However, the specific transabdominal US method for PDAC screening has lacked standardization across facilities in Japan. To increase the PDAC detection rate using transabdominal US, it is necessary to devise proper approaches for observing the pancreas in detail, such as sitting position, liquid intake, and choosing the right type of ultrasound probe, which should be standardized for PDAC screening across hospitals within the community 15 – 17 . Our study identified male sex, tumor location in the pancreatic head, tumor size ≤ 20 mm, cancer stage IIB–IV, curative surgical resection, and health checkups as factors significantly associated with overall survival (Study 1). Furthermore, in a separate analysis of the HC cohort (Study 2), we found that a tumor size ≤ 20 mm was also associated with survival exceeding 5 years. Previous studies have observed an increased rate of curative resection in PDAC patients with a tumor size ≤ 20 mm and a markedly lower incidence of lymph node metastasis 26 – 28 . In our study, curative surgical resection was possible in all patients who survived exceeding 5 years (data not shown). Curative surgical resection is an important prognostic factor in patients with PDAC 28 , 29 . However, no reports have explored the factors associated with long-term survival in patients with PDAC found through cancer screening during health checkups. Our analysis suggests that detecting PDAC at an earlier stage, before symptoms appear, can improve the patient's clinical course, with health checkups providing an opportunity for this. Although the current study is the largest to date to evaluate the clinical characteristics and prognosis of PDAC cases identified during health checkups, it has some limitations. First, information on the enrolled patients' health checkup history was incomplete. Second, the detailed findings of the initial imaging examination that led to PDAC detection were unclear. Third, Lim et al. 28 reported that socioeconomic status may influence the clinical course after diagnosis. In our study, the patients’ social backgrounds, including their residence area, family structure, education level, occupation, household wealth, and income, were not considered. Fourth, Pongprasobchai et al. 30 reported that histologic differentiation was the only independent factor predicting survival in patients who underwent curative resection for PDAC. In our study, some cases with unclear histologic differentiation were included, including those diagnosed solely by pancreatic juice cytology. Therefore, histologic differentiation was excluded from the evaluation. Fifth, while propensity score matching would have been the preferred method for comparing the HC and non-HC cohorts, it was not feasible due to the significant disparity in sample sizes between the two groups. Lastly, the observational retrospective design of this study may limit the generalizability of the findings. In conclusion, our study showed that asymptomatic patients diagnosed with PDAC via imaging modalities during health checkups have a better prognosis than those diagnosed after the emergence of symptoms. In these cases, a tumor size ≤ 20 mm was associated with survival exceeding 5 years after PDAC diagnosis. It is crucial to diagnose PDAC at an earlier stage without any symptoms during health checkups and ensure the tumor is suitable for curative surgical resection. To validate these results, prospective multicenter studies with large sample sizes are needed. In the future, it is necessary to establish a specific PDAC screening protocol that incorporates regular transabdominal US examination for high-risk patients, such as those with a family history of PDAC, smoking, heavy drinking, obesity, diabetes, pancreatic cysts, or chronic pancreatitis 10 , 11 . Methods Patients As in our previous reports 31 – 34 , this study enrolled 1,002 consecutive patients with pancreatic cancer diagnosed and treated at Kawasaki Medical School Hospital in Kurashiki City and Kawasaki Medical School General Medical Center in Okayama City from January 2011 to March 2025. These individuals included patients who were identified with pancreatic tumors at other hospitals and referred to our hospitals. Transabdominal US was performed on fasting participants in accordance with the standardized protocol for comprehensive abdominal scanning developed by the Japanese Society of Gastrointestinal Cancer Screening 35 . Patients were excluded if they were diagnosed and treated at different hospitals and referred to our hospital for palliative care (34 patients), had a pancreatic malignancy other than PDAC (100 patients; intraductal papillary mucinous carcinoma [50 patients], neuroendocrine carcinoma [44 patients], adenosquamous carcinoma [three patients], insulinoma [two patients], and extra-gastrointestinal stromal tumor [one patient]), died from a cause that was not PDAC-related (six patients). There was no bias in the PDAC staging of the excluded cases. The remaining 862 patients diagnosed with PDAC were enrolled in this study. All information was collected from medical records at our hospitals by gastroenterologists and digestive surgeons. This dual-center, retrospective, observational cohort study was conducted using an opt-out informed consent method, which was approved by the Research Ethics Committee of Kawasaki Medical School (approval number: 6852-3). Informed consent was obtained from all participants via this opt-out approach. Patients and the public were not involved in the design, conduct, reporting, or dissemination plans of this research. Variables and outcome The study flowchart is shown in Fig. 1 . In Study 1, the enrolled patients were divided into two cohorts: the health checkup cohort (HC cohort) and non-health checkup cohort (non-HC cohort). The HC cohort comprised asymptomatic patients diagnosed with PDAC following imaging examination during health checkups. The non-HC cohort comprised patients diagnosed with PDAC based on symptoms, including systemic workup for a primary malignancy other than PDAC and examination of the primary focus of a metastatic tumor. The baseline characteristics at the time of PDAC diagnosis included sex, age, drinking and smoking habits, body mass index, comorbidities, family history of malignancy, and blood test results at the time of PDAC diagnosis, such as glycated hemoglobin, carcinoembryonic antigen (CEA), and carbohydrate antigen 19 − 9 (CA19-9) levels. The tumor location, imaging findings, clinical or pathological staging, therapeutic procedures, and clinical course were compared between the HC and non-HC cohorts. PDAC stages were classified according to the American Joint Committee on Cancer 8th Edition. 36 For PDAC staging, pathological staging was used for patients who underwent curative surgical resection, whereas clinical staging was used for patients who did not undergo curative surgical resection. In Study 2, the associations between long-term survival after PDAC diagnosis and various factors at the time of diagnosis in the HC cohort were analyzed. Statistical analysis Data are expressed as mean ± standard deviation (SD) or median (interquartile range [IQR]) for continuous variables, and as numbers (percentages) for categorical variables. Pearson chi-squared tests were used to compare proportions between cohorts. Kaplan-Meier survival analysis was performed to estimate the impact on patients’ overall survival from the date of PDAC diagnosis. Differences in survival between the HC and non-HC cohorts were evaluated using the log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a multivariable Cox proportional hazards model to identify factors associated with overall survival. To identify factors associated with survival exceeding 5 years after PDAC diagnosis in the HC cohort, we calculated odds ratios (ORs) and 95% CIs using Mantel-Haenszel statistics and multivariable logistic regression models. A two-sided P -value < 0.05 was considered statistically significant. All statistical analyses were performed using IBM SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA). Abbreviations CA19-9, carbohydrate antigen; CEA, carcinoembryonic antigen; CI, confidence interval; CT, computed tomography; EUS, endoscopic ultrasonography; FDG-PET, 18F-fluorodeoxyglucose positron emission tomography; HC cohort, health checkup cohort; HR, hazard ratio; IQR, interquartile range; MRI, magnetic resonance imaging; non-HC cohort, non-health checkup cohort; OR, odds ratio; PDAC, pancreatic ductal adenocarcinoma; SD, standard deviation; US, ultrasonography. Declarations Acknowledgments The authors thank all staff members of the Department of Gastroenterology and Hepatology, Department of Clinical Pathology and Laboratory Medicine, and Department of Digestive Surgery at Kawasaki Medical School Hospital, as well as those of the Department of General Internal Medicine 2 and Department of General Surgery at Kawasaki Medical School General Medical Center. We thank J. Iacona, Ph.D., from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript. Author Contributions: Conceptualization: MF, NM, and KH; Methodology: MF and NM; Formal analysis and investigation: MF; Writing - original draft preparation and prepared figures and tables: MF; Writing - review and editing: NM and KH; Resources: TK, TT, MT, EB, TM, MA, TA, KY, AU, TY, HK, TU, JH; Supervision: TK, JH, and KH. All authors read and approved the final manuscript. Competing interests : The authors declare no conflict of interest relevant to this article. Funding statement: The authors received no funding. Ethics approval and consent: The protocol for this research project has been approved by a suitably constituted Ethics Committee of the institution, and it conforms to the provisions of the Declaration of Helsinki. The research ethics committee of Kawasaki Medical School Hospital approved this study (approval number: 6852-3). Data availability : The datasets generated during and/or analyzed during the current study are not available. All data generated or analyzed during this study are included in this article and its online supplementary material files. Further inquiries can be directed to the corresponding author. References Lu, J., Ningen & Dock Japan's unique comprehensive health checkup system for early detection of disease. Glob Health Med. 4 , 9–13 (2022). Pancreas & in cancer statistics, Cancer Information Service, National Cancer Center Research Institute., Japan. https://ganjoho.jp/reg_stat/statistics/stat/cancer/10_pancreas.html [accessed March 1, 2026]. Zhan, H. X., Xu, J. W., Wu, D., Zhang, T. P. & Hu, S. Y. Pancreatic cancer stem cells: new insight into a stubborn disease. Cancer Lett. 357 , 429–437 (2015). Egawa, S. et al. Clinicopathological aspects of small pancreatic cancer. Pancreas 28 , 235–240 (2004). Zhou, B. et al. 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Supplementary Files 9.SciRepSupplTable.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 29 Apr, 2026 Reviews received at journal 28 Apr, 2026 Reviews received at journal 22 Apr, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers invited by journal 27 Mar, 2026 Editor assigned by journal 20 Mar, 2026 Submission checks completed at journal 18 Mar, 2026 First submitted to journal 18 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9100031","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":612669140,"identity":"1085cd64-d81a-4f59-b469-ae0ec204af0a","order_by":0,"name":"Minoru Fujita","email":"data:image/png;base64,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","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Minoru","middleName":"","lastName":"Fujita","suffix":""},{"id":612669141,"identity":"ee255b40-dd24-4804-bdbd-d79d44ffe1a4","order_by":1,"name":"Noriaki Manabe","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Noriaki","middleName":"","lastName":"Manabe","suffix":""},{"id":612669142,"identity":"5199244e-270b-4336-9b4b-62f03ea000a2","order_by":2,"name":"Tomoari Kamada","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Tomoari","middleName":"","lastName":"Kamada","suffix":""},{"id":612669143,"identity":"1dfd36bb-c0de-4f37-b0b6-4e0c5a2cc7b6","order_by":3,"name":"Tomohiro Tanikawa","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Tomohiro","middleName":"","lastName":"Tanikawa","suffix":""},{"id":612669144,"identity":"bc3185d6-9588-47f0-962f-28fbb9d86885","order_by":4,"name":"Munenori Takaoka","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Munenori","middleName":"","lastName":"Takaoka","suffix":""},{"id":612669145,"identity":"4b90ee43-179e-4ab2-b2ff-28e12c6aa368","order_by":5,"name":"Emiko Bukeo","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Emiko","middleName":"","lastName":"Bukeo","suffix":""},{"id":612669146,"identity":"f7772bc5-7732-42d6-9f05-226713659325","order_by":6,"name":"Takahisa Murao","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Takahisa","middleName":"","lastName":"Murao","suffix":""},{"id":612669147,"identity":"5131c9bf-38ef-4bdc-ad69-35a80645bbb3","order_by":7,"name":"Maki Ayaki","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Maki","middleName":"","lastName":"Ayaki","suffix":""},{"id":612669148,"identity":"bc12ee5a-e705-4d81-889d-7aff60987c26","order_by":8,"name":"Takashi Akiyama","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Takashi","middleName":"","lastName":"Akiyama","suffix":""},{"id":612669149,"identity":"33661a4a-85ae-4369-96d4-4527b3d0f679","order_by":9,"name":"Koji Yoshida","email":"","orcid":"","institution":"Kawasaki Medical School Hospital","correspondingAuthor":false,"prefix":"","firstName":"Koji","middleName":"","lastName":"Yoshida","suffix":""},{"id":612669150,"identity":"85773856-c497-4c18-a3e9-70245da8525c","order_by":10,"name":"Atsushi Urakami","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Atsushi","middleName":"","lastName":"Urakami","suffix":""},{"id":612669151,"identity":"d979226c-465a-409e-a148-f8368222b5a1","order_by":11,"name":"Tomoki Yamatsuji","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Tomoki","middleName":"","lastName":"Yamatsuji","suffix":""},{"id":612669152,"identity":"0eb30d9d-2c09-4f31-8ca0-1b46d61b1cee","order_by":12,"name":"Hirofumi Kawamoto","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Hirofumi","middleName":"","lastName":"Kawamoto","suffix":""},{"id":612669153,"identity":"02e1085a-e456-4712-bb16-a7b51888bcff","order_by":13,"name":"Tomio Ueno","email":"","orcid":"","institution":"Kawasaki Medical School Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tomio","middleName":"","lastName":"Ueno","suffix":""},{"id":612669154,"identity":"605d6b09-c17a-4101-aa91-7e416bfc6fa7","order_by":14,"name":"Jiro Hata","email":"","orcid":"","institution":"Kawasaki Medical School Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiro","middleName":"","lastName":"Hata","suffix":""},{"id":612669155,"identity":"6f84fdee-1efe-431c-bf8d-92c67f6bf859","order_by":15,"name":"Ken Haruma","email":"","orcid":"","institution":"Kawasaki Medical School General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Ken","middleName":"","lastName":"Haruma","suffix":""}],"badges":[],"createdAt":"2026-03-12 04:38:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9100031/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9100031/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105573304,"identity":"d8f39507-3e29-405e-b071-6a8bfeff819a","added_by":"auto","created_at":"2026-03-27 13:31:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":732865,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy flow chart\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviations: HC cohort, health checkup cohort; non-HC cohort, non-health checkup cohort; PDAC, pancreatic ductal adenocarcinoma.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9100031/v1/237af6ba6cffb7413d748fb2.png"},{"id":105573021,"identity":"e3d58b95-d7d5-4cee-a5eb-d89885c0262c","added_by":"auto","created_at":"2026-03-27 13:30:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":232542,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrigger imaging examination for pancreatic ductal adenocarcinoma (PDAC) diagnosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(a) HC cohort; (b) non-HC cohort.\u003c/p\u003e\n\u003cp\u003e*, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001 versus the non-HC cohort.\u003c/p\u003e\n\u003cp\u003eAbbreviations: CT, computed tomography; FDG-PET, 18F-fluorodeoxyglucose positron emission tomography; HC cohort, health checkup cohort; MRI, magnetic resonance imaging; non-HC cohort, non-health checkup cohort; US, ultrasonography.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9100031/v1/af381553c3c18361b3dc7bc2.png"},{"id":105573051,"identity":"169633bd-5258-4081-bd08-b6f198712cf5","added_by":"auto","created_at":"2026-03-27 13:30:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":291360,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan-Meier survival curves for the health checkup (HC) and non-health checkup (non-HC) cohorts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviations: PDAC, pancreatic ductal adenocarcinoma.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9100031/v1/455e4ed123bdc90b060b0b68.png"},{"id":105576159,"identity":"65b25246-2e85-4250-bbb9-883a46803787","added_by":"auto","created_at":"2026-03-27 13:43:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3115974,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9100031/v1/fad4536f-fab5-446e-81b2-a3a38354e841.pdf"},{"id":105574982,"identity":"a1292366-7e4b-4d6b-a851-d123cbf886a6","added_by":"auto","created_at":"2026-03-27 13:37:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":78835,"visible":true,"origin":"","legend":"","description":"","filename":"9.SciRepSupplTable.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9100031/v1/30cfe328b98a2861903626c6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Beyond early detection: how health checkups independently contribute to pancreatic cancer survival outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eJapan has a unique health checkup system for early disease detection that has been developed over many years. The primary purpose of this system is to promote health through early detection of cancer and lifestyle-related diseases and to conduct regular health assessments. Basic examinations include physical measurements; blood tests (e.g., complete blood count, liver and renal function tests, and lipid metabolism); urine analysis; fecal occult blood test; chest X-ray; upper gastrointestinal X-ray or endoscopy; transabdominal ultrasonography (US); and gynecological examination. The examinee is responsible for the cost of such examinations. However, the Japanese health checkup system is considered a key factor in the longevity of its citizens, contributing to reduced overall health care expenditures through early detection and treatment\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e According to cancer statistics reported by the National Cancer Center Research Institute in Japan, pancreatic ductal adenocarcinoma (PDAC) is a highly lethal disease, for which mortality closely parallels incidence. A crude incidence rate of 36.5% per 100,000 population was observed in 2021, and a crude mortality rate of 34.3% per 100,000 population in 2024. Additionally, the crude mortality rate per 100,000 population has gradually increased, from 25.4% in 2015 to 34.3% in 2024\u003csup\u003e2\u003c/sup\u003e. Although PDAC is known to have a favorable prognosis when detected early (stage 0) or when smaller than 10 mm (Tumor Size 1a), it is often diagnosed at an advanced stage 3,4. The reasons for this include the absence of biomarkers for early-stage PDAC, its anatomical location in the retroperitoneum, which allows invasion of surrounding organs and blood vessels, and its non-specific symptoms\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Furthermore, most patients with PDAC remain asymptomatic until the disease reaches an advanced stage\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFor earlier detection of PDAC, previous reports have demonstrated the usefulness of various modalities, such as transabdominal US, abdominal computed tomography (CT), abdominal magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)\u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. However, the selection of examination methods for PDAC screening in Japan varies among institutions and is not standardized\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. While it has been reported that asymptomatic PDAC cases exhibit a more favorable prognosis than symptomatic cases\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, little research has examined the clinical differences between PDAC cases diagnosed during health checkups and those diagnosed at another time. To efficiently detect PDAC earlier in asymptomatic individuals, it is crucial to understand the clinical characteristics and prognosis of PDAC cases diagnosed during health checkups.\u003c/p\u003e \u003cp\u003eIn this study, we aimed to clarify the clinical characteristics of patients with PDAC and evaluate the effectiveness of cancer screening processes during health checkups.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy 1: Comparisons between the HC and non-HC cohorts\u003c/h2\u003e \u003cp\u003eOf the enrolled patients, 61 (7.1%) were in the health checkup cohort (HC cohort), and 801 (92.9%) were in the non-health checkup cohort (non-HC cohort).\u003c/p\u003e \u003cp\u003eDemographic data for the HC and non-HC cohorts are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The non-HC cohort had a significantly older mean age than the HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020). The proportion of patients with hyperlipidemia was markedly higher in the HC cohort than in the non-HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021). In contrast, the proportion of patients with cardiovascular disease was significantly higher in the non-HC cohort than in the HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036). No significant difference in the proportion of patients with a family history of malignancy, including PDAC, was observed between the HC and non-HC cohorts. CEA and CA19-9 levels were markedly higher in the non-HC cohort than in the HC cohort (both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data for the HC and non-HC cohorts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean age\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHC cohort\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enon-HC cohort\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;801)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (57.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e416 (51.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking habit, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e332 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking habit, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217 (27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.295\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eComorbidities and past histories, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e316 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235 (29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignant tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eFamily history, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignancy*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e218 (27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.927\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eBlood test results#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlycated hemoglobin (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCEA (ng/mL), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5 (1.8\u0026ndash;5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8 (2.8\u0026ndash;10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA19-9 (U/mL), median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93.3 (13.0\u0026ndash;358.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285.1 (42.9\u0026ndash;2744.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: Bold values indicate \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; *, including PDAC; #, value at the time of PDAC diagnosis. Abbreviations: CA19-9, carbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9; CEA, carcinoembryonic antigen; HC cohort, health checkup cohort; IQR, interquartile range; non-HC cohort, non-health checkup cohort; PDAC, pancreatic ductal adenocarcinoma; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comparison of the trigger imaging examination for PDAC diagnosis is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Transabdominal US was significantly more common in the HC cohort compared with the non-HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe PDAC characteristic comparisons between the HC and non-HC cohorts are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. No significant difference in tumor location was found between the HC and non-HC cohorts. Tumor size was significantly larger in the non-HC cohort than in the HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). There was no significant difference in the number of patients with main pancreatic duct dilatation (\u0026ge;\u0026thinsp;3 mm) between the two cohorts. For PDAC staging, stage IA (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and IIA (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) disease were significantly more frequent in the HC cohort than in the non-HC cohort. In contrast, stage IV PDAC was markedly more frequent in the non-HC cohort compared with the HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the HC cohort, curative surgical resection alone (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009) and curative surgical resection with neoadjuvant and/or adjuvant chemoradiotherapy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly more frequent. In contrast, patients receiving only palliative care were more frequent in the non-HC cohort than in the HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePDAC characteristic comparisons between the HC and non-HC cohorts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTumor location, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHC cohort\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enon-HC cohort\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;801)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e445 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.474\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e205 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImaging findings, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.4\u0026thinsp;\u0026plusmn;\u0026thinsp;13.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain pancreatic duct dilatation\u0026thinsp;\u0026ge;\u0026thinsp;3 mm, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (73.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e562 (70.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.554\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoexistence of intraductal papillary mucinous neoplasm, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer stage, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage IA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage IB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage IIA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage IIB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e388 (48.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatments, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurative surgical resection alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant and/or adjuvant chemoradiotherapy\u0026thinsp;+\u0026thinsp;curative surgical resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemoradiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e380 (47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePalliative care alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e271 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: Bold values indicate \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Abbreviations: HC cohort, health checkup cohort; non-HC cohort, non-health checkup cohort; PDAC, pancreatic ductal adenocarcinoma; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatient overall survival from the date of PDAC diagnosis was compared between the HC and non-HC cohorts using Kaplan-Meier survival analysis, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The survival curves indicate that the health checkup was significantly associated with a longer survival time after PDAC diagnosis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for the log-rank test). The 5-year survival rates for the HC and non-HC cohorts were 35.9% and 10.5%, respectively. The median survival times for the HC and non-HC cohorts were 3.9 years and 0.9 years, respectively. In multivariable analysis, male sex, tumor location in the pancreatic head, tumor size\u0026thinsp;\u0026le;\u0026thinsp;20 mm, cancer stage IIB\u0026ndash;IV, curative surgical resection, and health checkups were significantly associated with overall survival (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariable and multivariable analyses of factors associated with overall survival.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnivariable analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.139 (0.938\u0026ndash;1.384)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.234 (1.058\u0026ndash;1.439)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.275 (1.093\u0026ndash;1.489)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.020 (0.808\u0026ndash;1.288)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody/tail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.956 (0.734\u0026ndash;0.999)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.048\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.822 (0.704\u0026ndash;0.959)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.491 (0.407\u0026ndash;0.592)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.643 (0.530\u0026ndash;0.780)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;IIA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIIB\u0026ndash;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.297 (2.615\u0026ndash;4.157)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.457 (1.927\u0026ndash;3.133)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemoradiotherapy and/or palliative care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurative surgical resection*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.300 (0.239\u0026ndash;0.378)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.334 (0.164\u0026ndash;0.683)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.019 (0.682\u0026ndash;1.523)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.927\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.466 (0.216\u0026ndash;1.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth checkups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.350 (0.243\u0026ndash;0.502)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.424 (0.294\u0026ndash;0.610)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: Bold values indicate \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; *, including those in which neoadjuvant and/or adjuvant therapy was administered in addition to surgical resection. Abbreviations: CI, confidence interval; HR, Hazard ratio.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eStudy 2: Associations between long-term survival after PDAC diagnosis and various factors in the HC cohort\u003c/em\u003e \u003c/p\u003e \u003cp\u003eNext, we analyzed associations among patients who survived more than 5 years after PDAC diagnosis and various factors in the HC cohort. Multivariable analysis showed that tumor size\u0026thinsp;\u0026le;\u0026thinsp;20 mm was significantly associated with survival beyond 5 years after diagnosis in the HC cohort (adjusted OR, 6.667; 95% CI, 1.448\u0026ndash;30.747; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015; Supplemental Table\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we analyzed the clinical characteristics of PDAC cases identified during health checkups (HC cohort) compared with those diagnosed through methods other than health checkups (non-HC cohort). The non-HC cohort had a significantly older mean age than the HC cohort. CEA and CA19-9 levels were markedly lower in the HC cohort than in the non-HC cohort. Consistent with the tumor marker level results, the HC cohort individuals were diagnosed at an earlier stage, with a higher proportion of patients undergoing curative surgical resections compared with the non-HC cohort. Moreover, the 5-year survival rate of the HC cohort was 35.9%, while that of the non-HC cohort was 10.3%, and multivariable analysis identified male sex, tumor location in the pancreatic head, tumor size\u0026thinsp;\u0026le;\u0026thinsp;20 mm, cancer stage IIB\u0026ndash;IV, curative surgical resection, and health checkup as significant predictors of overall survival. Given that the global 5-year survival rate for PDAC is less than 12%\u003csup\u003e18\u003c/sup\u003e, our results suggest that cancer screening during health checkups contributes to early detection and treatment, leading to long-term survival after PDAC diagnosis. In Europe and the United States, routine screening with abdominal MRI or EUS is recommended for individuals with a strong family history and/or a high genetic risk of PDAC, such as \u003cem\u003eBRCA1/2\u003c/em\u003e, \u003cem\u003eLKB1/STK11\u003c/em\u003e, or \u003cem\u003eCDKN2A\u003c/em\u003e mutation. Conversely, screening for asymptomatic individuals at average risk is not recommended due to the low incidence of the disease\u003csup\u003e\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. However, only 25% of PDAC patients with stage 0 or stage I disease experience any symptoms, indicating the importance of surveillance in asymptomatic patients\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Additionally, previous work has shown that PDAC detected asymptomatically had a significantly smaller tumor size, earlier stage, higher tumor resection rate, and longer 5-year survival rate than symptomatic PDAC\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Therefore, diagnosing PDAC early, before any symptoms appear, contributes to early treatment and long-term survival for patients\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study also revealed that the proportion of patients for whom transabdominal US was the method leading to PDAC diagnosis was markedly higher in the HC cohort compared with the non-HC cohort. Although various modalities are used for PDAC, abdominal CT highly relies on ionizing radiation, and abdominal MRI takes 20 to 30 minutes to produce the image. Additionally, if the patient has metal implants in their body, then MRI examination becomes more challenging to perform. FDG-PET leads to a high radiation dose and is costly overall\u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. EUS is most useful in detecting PDAC tumors less than 10 mm compared with the other modalities\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. However, the EUS procedure poses a higher risk of gastrointestinal perforation relative to regular gastroscopy examination. Because EUS scopes for pancreato-biliary diseases place the ultrasound transducer positioned in front of the optical lens, the length and diameter of the scope are increased. As a result, the flexibility and maneuverability of the EUS scope are limited\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Therefore, it is challenging to frequently perform EUS, causing this approach to be unsuitable for PDAC screening of asymptomatic participants during health checkups. In contrast, transabdominal US is a non-invasive and cost-effective technique, making it a preferred modality for PDAC screening of asymptomatic individuals\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Takikawa et al.\u003csup\u003e8\u003c/sup\u003e reported that transabdominal US was the most commonly used imaging modality to detect PDAC in asymptomatic participants during health checkups. However, this approach has some limitations. The diagnostic accuracy of transabdominal US for PDAC depends on the skill of the operator and the condition of the patient, such as their physique, age, daily living activities, comorbidities, and the presence and amount of interfering intestinal gas. Our study revealed that tumor location in the pancreatic head and tumor size\u0026thinsp;\u0026le;\u0026thinsp;20 mm were significantly associated with overall survival in patients with PDAC. Patients with PDAC of the pancreatic head often present with obstructive jaundice, whereas those with PDAC in the body or tail tend to exhibit nonspecific symptoms, such as abdominal pain and weight loss. Consequently, PDAC of the pancreatic head is typically detected at an earlier stage, leading to relatively better survival rates\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Transabdominal US often fails to visualize the entire pancreas. Therefore, identifying small tumors in the pancreatic body or tail can be difficult\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. However, the specific transabdominal US method for PDAC screening has lacked standardization across facilities in Japan. To increase the PDAC detection rate using transabdominal US, it is necessary to devise proper approaches for observing the pancreas in detail, such as sitting position, liquid intake, and choosing the right type of ultrasound probe, which should be standardized for PDAC screening across hospitals within the community\u003csup\u003e\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur study identified male sex, tumor location in the pancreatic head, tumor size\u0026thinsp;\u0026le;\u0026thinsp;20 mm, cancer stage IIB\u0026ndash;IV, curative surgical resection, and health checkups as factors significantly associated with overall survival (Study 1). Furthermore, in a separate analysis of the HC cohort (Study 2), we found that a tumor size\u0026thinsp;\u0026le;\u0026thinsp;20 mm was also associated with survival exceeding 5 years. Previous studies have observed an increased rate of curative resection in PDAC patients with a tumor size\u0026thinsp;\u0026le;\u0026thinsp;20 mm and a markedly lower incidence of lymph node metastasis\u003csup\u003e\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. In our study, curative surgical resection was possible in all patients who survived exceeding 5 years (data not shown). Curative surgical resection is an important prognostic factor in patients with PDAC\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. However, no reports have explored the factors associated with long-term survival in patients with PDAC found through cancer screening during health checkups. Our analysis suggests that detecting PDAC at an earlier stage, before symptoms appear, can improve the patient's clinical course, with health checkups providing an opportunity for this.\u003c/p\u003e \u003cp\u003eAlthough the current study is the largest to date to evaluate the clinical characteristics and prognosis of PDAC cases identified during health checkups, it has some limitations. First, information on the enrolled patients' health checkup history was incomplete. Second, the detailed findings of the initial imaging examination that led to PDAC detection were unclear. Third, Lim et al.\u003csup\u003e28\u003c/sup\u003e reported that socioeconomic status may influence the clinical course after diagnosis. In our study, the patients\u0026rsquo; social backgrounds, including their residence area, family structure, education level, occupation, household wealth, and income, were not considered. Fourth, Pongprasobchai et al.\u003csup\u003e30\u003c/sup\u003e reported that histologic differentiation was the only independent factor predicting survival in patients who underwent curative resection for PDAC. In our study, some cases with unclear histologic differentiation were included, including those diagnosed solely by pancreatic juice cytology. Therefore, histologic differentiation was excluded from the evaluation. Fifth, while propensity score matching would have been the preferred method for comparing the HC and non-HC cohorts, it was not feasible due to the significant disparity in sample sizes between the two groups. Lastly, the observational retrospective design of this study may limit the generalizability of the findings.\u003c/p\u003e \u003cp\u003eIn conclusion, our study showed that asymptomatic patients diagnosed with PDAC via imaging modalities during health checkups have a better prognosis than those diagnosed after the emergence of symptoms. In these cases, a tumor size\u0026thinsp;\u0026le;\u0026thinsp;20 mm was associated with survival exceeding 5 years after PDAC diagnosis. It is crucial to diagnose PDAC at an earlier stage without any symptoms during health checkups and ensure the tumor is suitable for curative surgical resection. To validate these results, prospective multicenter studies with large sample sizes are needed. In the future, it is necessary to establish a specific PDAC screening protocol that incorporates regular transabdominal US examination for high-risk patients, such as those with a family history of PDAC, smoking, heavy drinking, obesity, diabetes, pancreatic cysts, or chronic pancreatitis\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eAs in our previous reports\u003csup\u003e\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e, this study enrolled 1,002 consecutive patients with pancreatic cancer diagnosed and treated at Kawasaki Medical School Hospital in Kurashiki City and Kawasaki Medical School General Medical Center in Okayama City from January 2011 to March 2025. These individuals included patients who were identified with pancreatic tumors at other hospitals and referred to our hospitals. Transabdominal US was performed on fasting participants in accordance with the standardized protocol for comprehensive abdominal scanning developed by the Japanese Society of Gastrointestinal Cancer Screening\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Patients were excluded if they were diagnosed and treated at different hospitals and referred to our hospital for palliative care (34 patients), had a pancreatic malignancy other than PDAC (100 patients; intraductal papillary mucinous carcinoma [50 patients], neuroendocrine carcinoma [44 patients], adenosquamous carcinoma [three patients], insulinoma [two patients], and extra-gastrointestinal stromal tumor [one patient]), died from a cause that was not PDAC-related (six patients). There was no bias in the PDAC staging of the excluded cases. The remaining 862 patients diagnosed with PDAC were enrolled in this study. All information was collected from medical records at our hospitals by gastroenterologists and digestive surgeons. This dual-center, retrospective, observational cohort study was conducted using an opt-out informed consent method, which was approved by the Research Ethics Committee of Kawasaki Medical School (approval number: 6852-3). Informed consent was obtained from all participants via this opt-out approach. Patients and the public were not involved in the design, conduct, reporting, or dissemination plans of this research.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVariables and outcome\u003c/h3\u003e\n\u003cp\u003eThe study flowchart is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn Study 1, the enrolled patients were divided into two cohorts: the health checkup cohort (HC cohort) and non-health checkup cohort (non-HC cohort). The HC cohort comprised asymptomatic patients diagnosed with PDAC following imaging examination during health checkups. The non-HC cohort comprised patients diagnosed with PDAC based on symptoms, including systemic workup for a primary malignancy other than PDAC and examination of the primary focus of a metastatic tumor. The baseline characteristics at the time of PDAC diagnosis included sex, age, drinking and smoking habits, body mass index, comorbidities, family history of malignancy, and blood test results at the time of PDAC diagnosis, such as glycated hemoglobin, carcinoembryonic antigen (CEA), and carbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9 (CA19-9) levels. The tumor location, imaging findings, clinical or pathological staging, therapeutic procedures, and clinical course were compared between the HC and non-HC cohorts. PDAC stages were classified according to the American Joint Committee on Cancer 8th Edition.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e For PDAC staging, pathological staging was used for patients who underwent curative surgical resection, whereas clinical staging was used for patients who did not undergo curative surgical resection.\u003c/p\u003e \u003cp\u003eIn Study 2, the associations between long-term survival after PDAC diagnosis and various factors at the time of diagnosis in the HC cohort were analyzed.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median (interquartile range [IQR]) for continuous variables, and as numbers (percentages) for categorical variables. Pearson chi-squared tests were used to compare proportions between cohorts. Kaplan-Meier survival analysis was performed to estimate the impact on patients\u0026rsquo; overall survival from the date of PDAC diagnosis. Differences in survival between the HC and non-HC cohorts were evaluated using the log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a multivariable Cox proportional hazards model to identify factors associated with overall survival. To identify factors associated with survival exceeding 5 years after PDAC diagnosis in the HC cohort, we calculated odds ratios (ORs) and 95% CIs using Mantel-Haenszel statistics and multivariable logistic regression models. A two-sided \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All statistical analyses were performed using IBM SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCA19-9, carbohydrate antigen; CEA, carcinoembryonic antigen; CI, confidence interval; CT, computed tomography; EUS, endoscopic ultrasonography; FDG-PET, 18F-fluorodeoxyglucose positron emission tomography; HC cohort, health checkup cohort; HR, hazard ratio; IQR, interquartile range; MRI, magnetic resonance imaging; non-HC cohort, non-health checkup cohort; OR, odds ratio; PDAC, pancreatic ductal adenocarcinoma; SD, standard deviation; US, ultrasonography.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all staff members of the Department of Gastroenterology and Hepatology, Department of Clinical Pathology and Laboratory Medicine, and Department of Digestive Surgery at Kawasaki Medical School Hospital, as well as those of the Department of General Internal Medicine 2 and Department of General Surgery at Kawasaki Medical School General Medical Center. We thank J. Iacona, Ph.D., from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eConceptualization: MF, NM, and KH; Methodology: MF and NM; Formal analysis and investigation: MF; Writing - original draft preparation and prepared figures and tables: MF; Writing - review and editing: NM and KH; Resources:\u0026nbsp;TK, TT, MT, EB, TM, MA, TA, KY, AU, TY, HK, TU, JH; Supervision: TK, JH, and KH. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest relevant to this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u0026nbsp;\u003c/strong\u003eThe authors received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent:\u003c/strong\u003e The protocol for this research project has been approved by a suitably constituted Ethics Committee of the institution, and it conforms to the provisions of the Declaration of Helsinki. The research ethics committee of Kawasaki Medical School Hospital approved this study (approval number: 6852-3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe datasets generated during and/or analyzed during the current study are not available. All data generated or analyzed during this study are included in this article and its online supplementary material files. Further inquiries can be directed to the corresponding author.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLu, J., Ningen \u0026amp; Dock Japan's unique comprehensive health checkup system for early detection of disease. \u003cem\u003eGlob Health Med.\u003c/em\u003e \u003cb\u003e4\u003c/b\u003e, 9\u0026ndash;13 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePancreas \u0026amp; in cancer statistics, Cancer Information Service, National Cancer Center Research Institute., Japan. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ganjoho.jp/reg_stat/statistics/stat/cancer/10_pancreas.html\u003c/span\u003e\u003cspan address=\"https://ganjoho.jp/reg_stat/statistics/stat/cancer/10_pancreas.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [accessed March 1, 2026].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhan, H. 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(2001).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePancreatic cancer stages reported by the American Cancer Society. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cancer.org/content/dam/CRC/PDF/Public/8780.8700.pdf\u003c/span\u003e\u003cspan address=\"https://www.cancer.org/content/dam/CRC/PDF/Public/8780.8700.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [accessed March 1, 2026].\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health checkup, overall survival, pancreatic ductal adenocarcinoma, transabdominal ultrasonography, tumor size","lastPublishedDoi":"10.21203/rs.3.rs-9100031/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9100031/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAlthough early detection of pancreatic ductal adenocarcinoma (PDAC) remains challenging, health checkups may improve clinical outcomes. This retrospective study compared the clinical characteristics of PDAC cases identified during health checkups (HC cohort, 61 patients) with those diagnosed through other methods (non-HC cohort, 801 patients). Transabdominal ultrasonography was more frequently utilized in the HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Patients in the HC cohort were significantly younger (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with lower CEA and CA19-9 levels and smaller tumor sizes (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Notably, the HC cohort showed significantly higher proportions of stage IA and stage IIA disease and higher rates of curative surgical resection (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Overall survival in the HC cohort was significantly higher than in the non-HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 for log-rank test and multivariable analysis), and tumor size\u0026thinsp;\u0026le;\u0026thinsp;20 mm was significantly associated with survival exceeding 5 years in the HC cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015). Our findings suggest that health checkups facilitate earlier diagnosis of PDAC and improve long-term prognosis. Establishing a standardized screening system using transabdominal ultrasonography, specifically optimized to detect tumors\u0026thinsp;\u0026le;\u0026thinsp;20 mm, is essential to improving survival in patients with PDAC.\u003c/p\u003e","manuscriptTitle":"Beyond early detection: how health checkups independently contribute to pancreatic cancer survival outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-27 13:04:36","doi":"10.21203/rs.3.rs-9100031/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-29T17:38:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T11:23:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-22T20:50:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43991976265749080504738409601422073060","date":"2026-04-22T15:39:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259963128812973292494820745730320625016","date":"2026-04-17T14:25:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-27T13:46:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-20T08:31:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-18T06:33:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-03-18T04:01:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ebf2109f-aecd-451d-a0db-a63f3ff65799","owner":[],"postedDate":"March 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T17:53:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-27 13:04:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9100031","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9100031","identity":"rs-9100031","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}