The Role of Serum Uric Acids in Protecting Postoperative Survival in Pancreatic Cancer

The Role of Serum Uric Acids in Protecting Postoperative Survival in Pancreatic Cancer | 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 Research Article The Role of Serum Uric Acids in Protecting Postoperative Survival in Pancreatic Cancer zhengping an, shen chen, chenyanng wei, pengfei li, ping yue, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9008446/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Although elevated serum uric acid (SUA) is a known risk factor for cancer-related death, its prognostic role after pancreatic cancer surgery remains unclear. This retrospective study of 198 patients who underwent pancreatic cancer surgery, 168 of whom received curative treatment. Of these patients, 119 (70.8%) exhibited increased SUA levels postoperatively, while 49 (29.2%) experienced decreased or stable levels. Patients with decreased or stable SUA exhibited better three-year overall survival (16.3% vs. 12.9%) and recurrence-free survival (17.4% vs. 9.2%). Multivariate analysis identified AJCC stage III as a significant risk factor for all-cause mortality (OR 7.065, p = 0.002). Cox regression analysis identified AJCC stage III (HR 2.157, p = 0.002), elevated SUA (HR 0.996, p = 0.005), and neurovascular invasion (HR 2.421, p < 0.001) as independent predictors of poorer overall survival. Similar trends were observed for recurrence-free survival. No significant differences were found in the palliative group. Early detection of these factors may facilitate timely intervention and improve outcomes. Serum uric acid pancreatic cancer overall survival recurrence-free survival Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. Introduction Pancreatic cancer is the most common solid tumor of the pancreas, accounting for over 95% of all pancreatic tumors [ 1 ] . This disease exhibits highly aggressive biological features and often presents with subtle early symptoms. The median survival is about 4 months, with a 5-year survival rate of 13% [ 2 ] . Notably, incidence rates among younger individuals (15–39 years old) have increased in recent years, with a global age-standardized incidence rate of 0.2% [ 3 , 4 , 5 ] . This trend may be linked to the rising prevalence of obesity [ 3 ] . Epidemiological data show that approximately 57% of pancreatic cancer patients already have metastasis at diagnosis [ 6 ] . Metastases mainly occur in the liver (75–80%), peritoneum (13–30%), lungs (15–18%), and extra-regional lymph nodes (12%) [ 7 ] . For pancreatic cancer without metastasis, resectability mainly depends on the involvement of key peripancreatic vessels, including the superior mesenteric artery, celiac trunk, hepatic artery branches, and portal vein axis. These are classified into three categories: Primary Resectable Pancreatic Cancer (PRPC), Borderline Resectable Pancreatic Cancer (BRPC), and Locally Advanced Pancreatic Cancer (LAPC) [ 8 ] . In current treatment strategies, palliative chemotherapy is the standard approach for metastatic pancreatic cancer [ 9 ] . For localized pancreatic cancer, surgical resection combined with adjuvant chemotherapy is recommended [ 10 ] , providing patients with the best chance for long-term survival. However, high postoperative recurrence rates—reaching 48% at 12 months and 86% at 5 years [ 11 , 12 ] —result in a 5-year overall survival rate of only 17% after curative resection [ 13 ] . For patients with resectable or borderline resectable pancreatic cancer, radical surgery is performed. For those with advanced pancreatic cancer, such as cases involving biliary obstruction, palliative treatment is primarily used [ 14 ] . Curative surgery typically involves pancreaticoduodenectomy as the primary procedure [ 15 ] , followed by distal pancreatectomy (i.e., pancreatic body-tail resection) [ 16 ] and total pancreatectomy [ 17 ] . However, treating pancreatic cancer remains difficult. First, there is a lack of practical screening tools to identify high-risk populations [ 18 ] . Second, reliable factors for predicting long-term survival are minimal [ 13 ] . Uric acid, as the end product of purine metabolism [ 19 ] , is primarily processed through renal and intestinal pathways [ 20 ] . At physiological pH, this weak acid (pKa 5.8) mainly exists as urate [ 21 ] . Current research shows that low serum uric acid levels are a risk factor for various cancers [ 22 – 24 ] . Kühn et al. found that uric acid levels inversely correlate with breast cancer risk (HR: 0.72, 95% CI: 0.53–0.99) and cancer mortality (HR: 0.75, 95% CI: 0.58–0.98), suggesting that higher SUA levels may serve as a useful prognostic marker for breast cancer patients [ 22 ] . However, other studies indicate that elevated SUA levels could increase cancer mortality risk [ 25 – 27 ] . Strasak et al. [ 24 ] examined the relationship between SUA and antioxidant/protective effects against cancer in a large cohort of 28,613 elderly Austrian women. Their findings contradicted the antioxidant/protective hypothesis, implying that elevated SUA levels might reflect poor prognosis. Yan et al. [ 26 ] demonstrated through a meta-analysis that higher SUA levels raise the risk of overall cancer incidence and mortality, challenging the idea of SUA's protective role in cancer. Huang et al. [ 25 ] in a prospective cohort study involving 444,462 participants from the UK Biobank, proposed that SUA has a sex-specific impact on hepatobiliary and pancreatic cancers, with elevated SUA levels being risk factors for pancreatic cancer in women and gallbladder cancer in men. Nonetheless, the connection between SUA levels and postoperative outcomes in pancreatic cancer patients remains unclear. Therefore, this retrospective study aims to analyze SUA level trends over time in pancreatic cancer patients and systematically evaluate the potential relationship between SUA levels and postoperative clinical outcomes. 2. Materials and methods 2.1 Study design and participants This is a single-center, retrospective cohort study designed to determine whether controlling serum uric acid levels offers postoperative survival benefits for patients with pancreatic cancer. Patients provided informed consent before surgery. This study adheres to the Declaration of Helsinki and is registered on clinicaltrials.gov (NCT07091526). It was approved by the Ethics Committee of the First Hospital of Lanzhou University. Based on previous studies, we defined "Increased" serum uric acid (SUA) as a postoperative increase of more than 10% compared to preoperative levels. At the same time, all other values were classified as "Decreased/Stable" [ 28 ][ 29 ] . This study collected data from 815 patients admitted to the First Hospital of Lanzhou University between 2016 and 2024 with a diagnosis of pancreatic malignancy. Among these, 198 cases were included. Exclusion criteria were: patients who did not undergo surgical treatment, those who received emergency hemodialysis or plasma exchange after surgery, patients with gout or a history of long-term urate-lowering therapy (e.g., allopurinol), patients lacking follow-up data, and patients with non-pancreatic primary tumors. 2.2 Data collection Extract clinical data from electronic medical records. Patient demographics include age, gender, body mass index (BMI), smoking history, alcohol consumption history, diabetes, and hypertension. Laboratory tests include total bilirubin, direct bilirubin, indirect bilirubin, uric acid, and CA199. Intraoperative details include the surgical approach, tumor location, and neurovascular invasion. Record postoperative complications such as pancreatic fistula, biliary fistula, postoperative hemorrhage, and intra-abdominal infection. Document perioperative information, including the surgical approach, tumor location, neurovascular invasion, postoperative pathological staging (TNM), length of hospital stay, and hospitalization costs. After recording all subjects' baseline information, subsequent researchers will verify and confirm that there are no default entries before completing the subject registration form. 2.3 Outcomes The primary outcomes of this study are overall survival and recurrence-free survival, with follow-up continuing through August 2024. Overall survival is the time from surgical treatment to death from any cause; recurrence-free survival is the time from treatment to tumor recurrence or death. Secondary outcomes include length of hospital stay, hospitalization costs, and postoperative complications such as pancreatic fistula, biliary fistula, hemorrhage, and intra-abdominal infection. Based on the results of postoperative whole-abdominal contrast-enhanced CT scans, assist in determining and accurately documenting cancer recurrence and metastasis. 2.4 Statistical analysis For data showing characteristics of quantitative information and following a normal distribution, the mean ± standard deviation (x ± s) was used for description. For categorical data, frequency (N) and percentage (%) were used. Categorical variables were analyzed with chi-square tests. Univariate logistic regression models identified potential factors associated with postoperative complications. Variables with P < 0.05 in univariate analysis were included in multivariate logistic regression models to determine independent risk factors. Multiple linear regression models analyzed factors affecting postoperative length of stay and hospitalization costs, examining the impact of multiple variables on continuous outcomes. Univariate and multivariate analyses were performed using Cox proportional hazards regression models to evaluate factors influencing patient survival. Kaplan-Meier survival curves were plotted, and differences between groups were compared with the log-rank test. All statistical tests were two-sided, with P < 0.05 as the threshold for significance. Data analysis was conducted using SPSS Statistics version 26, and graphical representations were created with GraphPad Prism 10.0. 3. Results 3.1Baseline and perioperative characteristics A retrospective analysis was performed on 815 patients diagnosed with pancreatic malignancies from 2016 to 2024. After screening, 617 patients were excluded from the study (Fig. 1 ). The remaining 198 patients were divided into two groups based on the surgical approach and further categorized according to the degree of postoperative SUA increase: the SUA elevation group (n = 119, 70.8%) and the SUA decrease/stable group (n = 49, 29.2%). Table 1 displays the baseline and perioperative characteristics of patients in the radical resection group. Significant differences were observed between the groups in alcohol history, tumor location, surgical type, preoperative SUA, and postoperative SUA. No significant differences were noted in other characteristics (Table 1 ). Among patients receiving palliative treatment, the SUA elevation group included 20 patients (66.67%), while the SUA decrease/stability group comprised 10 patients (33.33%). Table 2 presents the baseline and perioperative characteristics of patients in the palliative treatment group. No statistically significant differences were identified between the groups regarding any baseline or perioperative characteristics (Table 2 ). Table 1 Demographics of the Uric Acid Reduction/Stabilization Group and Uric Acid Elevation Group Based on Propensity Score Matching (Radical Resection Group) Variables Group P- value Total (N = 168) Decreased/Stable SUA2(N = 49) Increased SUA (N = 119) Age, years, mean ± SD 64.98 ± 10.33 63.24 ± 12.15 0.382 Gender, N (%) 0.259 Male 102 (60.72) 33(67.35) 69(57.98) Female 66 (39.28) 16(32.65) 50(42.02) BMI, kg/m 2 , mean ± SD 22.50 ± 3.10 21.90 ± 3.16 0.264 Hypertension, N(%) 38(22.62) 8(16.33) 30(25.21) 0.211 Diabetes, N(%) 43(25.60) 11(22.45) 32(26.89) 0.549 Smoking History, N(%) 85(50.60) 24(48.98) 61(51.26) 0.788 History of Alcohol Consumption, N(%) 49(29.17) 23(46.94) 26(21.85) 0.001 Pathological Subtyping, N(%) 0.323 Adenocarcinoma 164(97.62) 49(100.00) 115(96.64) Non-adenocarcinoma 4(2.38) 0(0.00) 4(3.36) Tumor location, N(%) 0.033 Head of pancreas 34(20.24) 10(20.41) 24(20.17) Pancreatic body and tail 30(17.86) 3(6.12) 27(22.69) Pancreatic 104(61.90) 36(73.47) 68(57.14) Neurovascular invasion, N(%) 83(49.40) 27(55.10) 56(47.06) 0.343 AJCC Staging, N(%) 0.506 1、2 142(84.52) 40(81.60) 102(85.72) 3 26(15.48) 9(18.40) 17(14.28) Type of Surgery, N(%) 0.009 Pancreaticoduodenectomy 133(79.17) 45(91.84) 88(73.95) Distal Pancreatectomy 35(20.83) 4(8.16) 31(26.05) BMI, Body Mass Index; AJCC, American Joint Committee on Cancer Table 2 Demographics of the Uric Acid Reduction/Stabilization Group and the Uric Acid Elevation Group (Palliative Care Group) Variables Group P- value Total (N = 30) Decreased/Stable SUA(N = 10) Increased SUA (N = 20) Age, years, mean ± SD 71.50 ± 12.33 66.90 ± 8.55 0.241 Gender, N (%) 0.584 Male 20 (66.67) 6(60.00) 14(70.00) Female 10 (33.33) 4(40.00) 6(30.00) BMI, kg/m 2 , mean ± SD 21.32 ± 3.34 21.67 ± 4.30 0.824 Hypertension, N(%) 5(16.67) 1(10.00) 4(20.00) 0.488 Diabetes, N(%) 9(30.00) 3(30.00) 6(30.00) 1.000 Smoking History, N(%) 4(13.33) 1(10.00) 3(15.00) 0.704 History of Alcohol Consumption, N(%) 1(3.33) 0(0.00) 1(5.00) 0.472 Table 3 shows the secondary outcome measures in the Radical Resection Group; there were no significant differences between the two groups in hospital stay length, hospitalization costs, or the rate of postoperative complications, including pancreatic fistula, biliary fistula, bleeding, and intra-abdominal infection (Table 3 , p > 0.05). Changes in serum uric acid levels after surgery did not significantly impact short-term perioperative results. Table 3 Secondary Outcome Measures in the Uric Acid Reduction/Stabilization Group and the Uric Acid Elevation Group Before Propensity Score Matching (Radical Resection Group) Variables Group P- value Total (N = 168) Decreased/Stable SUA(N = 49) Increased SUA (N = 119) Length of hospital stay /D 27.53 ± 9.88 24.85 ± 9.05 0.091 Hospitalization Costs /× 10⁴ CNY 9.56 ± 3.12 8.39 ± 3.05 0.027 Pancreatic fistula, N(%) 67(39.88) 16(32.65) 51(42.86) 0.220 Biliary fistula, N(%) 5(2.98) 1(2.04) 4(3.36) 0.967 Bleeding, N(%) 11(6.55) 2(4.08) 9(7.56) 0.627 Intra-abdominal infection, N(%) 83(49.40) 24(48.98) 59(49.58) 0.944 3.2 Survival situation In the radical resection group, the decreased/stable subgroup showed a significantly longer median OS (18.0 ± 1.467 months vs. 8.0 ± 0.898 months; HR, 2.508; 95% CI 1.645–3.823; p < 0.001, Fig. 2 A). This group also experienced a notably better median RFS (16.0 ± 2.027 months compared to 7.0 ± 0.550 months; HR, 2.486; 95% CI 1.565–3.951; p < 0.001, Fig. 2 B). In the palliative treatment group, the survival difference between the two cohorts did not reach statistical significance (HR, 3.589; 95% CI 0.793–16.245; p = 0.0684, Fig. 6 ). There was no statistically significant difference in overall survival (OS) between patients with AJCC stage I disease in the radical resection group (16.0 ± 0.944 months vs. 0.0 ± 0.000 months; HR, 1.443; 95% CI 0.643–3.239; p = 0.359; Fig. 3 A). Similarly, no significant difference was observed in RFS (12.0 ± 2.078 months vs. 8.0 ± 0.502 months; HR, 2.021; 95% CI 1.002–4.076; p = 0.643, Fig. 4 A). Among patients undergoing radical resection for AJCC stage II disease, median overall survival was better in the group with decreased or stable SUA levels compared to the group with elevated levels (18.0 ± 2.365 months vs. 5.0 ± 1.723 months; HR, 2.656; 95% CI 1.306–5.401; p < 0.001, Fig. 3 B). Median recurrence-free survival was also longer in the decreased or stable group than in the increased group (16.0 ± 1.258 months vs. 4.0 ± 1.018 months; HR, 2.224; 95% CI 1.188–4.164; p = 0.012, Fig. 4 B). Among patients undergoing radical resection for AJCC Stage III disease, median overall survival was better in the group with decreased or stable SUA levels compared to the group with elevated levels (24.0 ± 3.493 months vs. 2.0 ± 0.376 months; HR, 6.559; 95% CI 2.029–21.198; p < 0.001, Fig. 3 C). Median recurrence-free survival was also longer in the decreased/stable group compared to the increased group (24.0 ± 2.442 months vs. 1.0 ± 0.000 months; HR, 5.783; 95% CI 1.810–18.480; p < 0.001, Fig. 4 C). Survival analysis of 168 patients in the radical resection group, stratified by AJCC stage, showed significant differences in overall survival rates among stages I, II, and III (p = 0.008, Fig. 5 A), although no statistically significant difference was observed in recurrence-free survival (p = 0.1278; Figs. 5 B). 3.3 Analysis of prognostic factors in the Radical Resection Group before propensity score matching In the radical resection group, univariate analysis showed that AJCC stage III (OR 8.786, 95% CI 2.0920–36.905, p = 0.003) and postoperative hemorrhage (OR 7.959, 95% CI 1.262–50.193, p = 0.027) were linked to overall mortality. Multivariate analysis further confirmed that AJCC stage III (OR 7.440, 95% CI 2.127–26.027, p = 0.002) was an independent predictor of overall mortality (Table 6 ). Cox regression analysis identified that AJCC stage III, elevated SUA levels, postoperative bleeding, neurovascular involvement, increased preoperative total bilirubin, and higher preoperative direct bilirubin levels were associated with overall survival (OS). Subsequently, multivariate Cox proportional hazards analysis demonstrated that AJCC stage III (HR 2.225, 95% CI 1.359–3.641, p = 0.001), elevated SUA levels (HR 3.004, 95% CI 0.994–0.999, p < 0.001), and neurovascular invasion (HR 2.456, 95% CI 1.574–3.834, p < 0.001) were independent prognostic factors affecting patient survival (Table 7 ). Table 6 Risk Factors for Overall Mortality in Univariate and Multivariate Regression Analysis (Radical Resection Group) Variables Univariate Multivariate OR 95%CI P- value OR 95%CI P- value Age (increasing) 1.306 0.639–2.673 0.464 Sex, male (female ref.) 1.003 0.972–1.036 0.843 BMI (increasing) 1.006 0.892–1.134 0.928 AJCC III(I、II) 8.786 2.0920–36.905 0.003 7.440 2.127–26.027 0.002 Surgical Approach, PD (DP) 1.221 0.475–3.139 0.678 Pancreatic fistula (positive) 0.587 0.269–1.281 0.181 Biliary fistula (positive) 0.444 0.050–3.951 0.466 Bleeding (positive) 7.959 1.262–50.193 0.027 3.466 0.695–17.274 0.129 Intra-abdominal infection (positive) 0.724 0.331–1.585 0.419 Increased SUA (dec./stable SUA ref.) 0.729 0.290–1.833 0.501 Preoperative CA199(increasing) 1.000 0.999–1.001 0.609 Neurovascular involvement (positive) 1.774 0.860–3.659 0.120 Preoperative Total Bilirubin (increasing) 1.000 0.996–1.004 0.919 Preoperative Direct Bilirubin (increasing) 0.996 0.992–1.001 0.119 Preoperative indirect bilirubin (increasing) 0.997 0.994–1.001 0.116 OR, Odds Ratio Table 7 Cox Proportional Hazards Analysis of Overall Survival Prognostic Factors Before Propensity Score Matching (Radical Resection Group) Variables Univariate Multivariate HR 95%CI P- value HR 95%CI P- value Age (increasing) 0.997 0.980–1.016 0.780 Sex, male (female ref.) 1.337 0.885–2.201 0.167 BMI (increasing) 1.004 0.941–1.071 0.912 AJCC III(I、II) 1.785 1.109–2.875 0.017 2.225 1.359–3.641 0.001 Surgical Approach, PD (DP) 1.200 0.731–1.970 0.470 Increased SUA (dec./stable SUA ref.) 0.997 0.996–0.999 0.002 3.004 0.994–0.999 < 0.001 Preoperative CA199(increasing) 1.000 0.999–1.001 0.940 Pancreatic fistula (positive) 0.844 0.552–1.291 0.435 Biliary fistula (positive) 1.002 0.246–4.086 0.998 Bleeding (positive) 2.146 1.075–4.282 0.030 1.726 0.836–3.563 0.140 Intra-abdominal infection (positive) 0.972 0.647–1.461 0.893 Neurovascular involvement (positive) 1.863 1.229–2.825 0.003 2.456 1.574–3.834 < 0.001 Preoperative Total Bilirubin (increasing) 0.998 0.996-1.000 0.015 0.999 0.997–1.001 0.359 Preoperative Direct Bilirubin (increasing) 0.997 0.995-1.000 0.044 0.999 0.996–1.002 0.527 Preoperative indirect bilirubin (increasing) 1.001 0.999–1.003 0.388 HR, Hazard Ratio Additionally, we performed Cox regression analysis on recurrence-free survival within the radical resection group, and the results showed that AJCC stage III, elevated SUA levels, neurovascular invasion, higher preoperative total bilirubin, and increased preoperative direct bilirubin were linked to recurrence timing. Multivariate analysis revealed that AJCC stage III (HR 1.872, 95% CI 1.171–2.993, p = 0.009), SUA levels (HR 2.961, 95% CI 1.840–4.764, p < 0.001), and neurovascular invasion (HR 2.253, 95% CI 1.526–3.327, p < 0.001) are independent prognostic factors influencing recurrence timing (Table 8 ). Table 8 Cox Proportional Hazards Analysis of Prognostic Factors for Recurrence-Free Survival Before Propensity Score Matching (Radical Resection Group) Variables Univariate Multivariate HR 95%CI P- value HR 95%CI P- value Age (increasing) 0.993 0.977–1.009 0.385 Sex, male (female ref.) 1.262 0.870–1.832 0.220 BMI (increasing) 1.000 0.944–1.059 0.998 AJCC III(I、II) 1.390 0.878–2.201 0.160 Surgical Approach, PD (DP) 1.216 0.780–1.895 0.388 Increased SUA (dec./stable SUA ref.) 0.998 0.996–0.999 0.001 2.961 1.840–4.764 < 0.001 Preoperative CA199(increasing) 1.000 0.999-1.000 0.712 Pancreatic fistula (positive) 0.838 0.573–1.227 0.365 Biliary fistula (positive) 1.071 0.339–3.382 0.906 Bleeding (positive) 1.523 0.770–3.013 0.226 Intra-abdominal infection (positive) 0.929 0.644–1.339 0.693 Neurovascular involvement (positive) 1.757 1.210–2.552 0.003 2.253 1.526–3.327 < 0.001 Preoperative Total Bilirubin (increasing) 0.998 0.996–0.999 0.006 0.999 0.998–1.001 0.523 Preoperative Direct Bilirubin (increasing) 0.997 0.995–0.999 0.016 0.999 0.996–1.001 0.369 Preoperative indirect bilirubin (increasing) 1.000 0.999–1.002 0.847 HR, Hazard Ratio Both univariate and multivariate analyses showed no statistically significant differences in gender or age. A previous retrospective study indicated that pancreaticoduodenectomy and pancreaticoduodenectomy with resection of the pancreatic body and tail are standard procedures tailored to different tumor locations, with no statistically significant difference in survival rates between the two approaches [ 30 ] . The findings of this study align with the conclusion above, suggesting that the type of surgery does not significantly impact the overall survival time of pancreatic cancer patients. 3.4 Analysis of prognostic factors in Palliative Care Group In the palliative treatment group, both univariate and multivariate regression analyses showed that none of the clinical variables, including age, sex, BMI, SUA levels, preoperative CA199 levels, and bilirubin levels, were significantly correlated with overall mortality (Table 4 , p > 0.05). Further confirmation that these variables held no significant predictive value for overall survival was provided by Cox regression analysis (Table 5 , p > 0.05). Consequently, in this patient cohort, SUA levels did not constitute an independent factor influencing mortality risk or overall survival, like other conventional clinical indicators. Table 4 Risk Factors for Overall Mortality in Univariate and Multivariate Regression Analysis (Palliative Care Group) Variables Univariate Multivariate OR 95%CI P- value OR 95%CI P- value Age (increasing) 1.035 0.903 ~ 1.185 0.621 Sex, male (female ref.) 1.000 0.037 ~ 26.658 1.000 BMI (increasing) 1.008 0.627 ~ 1.620 0.974 Increased SUA (dec./stable SUA ref.) 0.992 0.969 ~ 1.017 0.534 Preoperative CA199(increasing) 0.998 0.995 ~ 1.002 0.361 Preoperative Total Bilirubin (increasing) 0.988 0.965 ~ 1.012 0.325 Preoperative Direct Bilirubin (increasing) 1.008 0.975 ~ 1.043 0.620 Preoperative indirect bilirubin (increasing) 1.005 0.983 ~ 1.028 0.648 OR, Odds Ratio Table 5 Cox Proportional Hazards Analysis of Overall Survival Prognostic Factors (Palliative Care Group) Variables Univariate Multivariate HR 95%CI P- value HR 95%CI P- value Age (increasing) 0.963 0.887–1.046 0.368 Sex, male (female ref.) 0.861 0.180–4.107 0.851 BMI (increasing) 1.033 0.902–1.183 0.636 Increased SUA (dec./stable SUA ref.) 0.992 0.976–1.008 0.332 Preoperative CA199(increasing) 1.000 0.998–1.002 0.974 Preoperative Total Bilirubin (increasing) 1.004 0.983–1.026 0.684 Preoperative Direct Bilirubin (increasing) 0.989 0.960–1.019 0.453 Preoperative indirect bilirubin (increasing) 0.996 0.985–1.007 0.489 HR, Hazard Ratio In the palliative treatment group, the SUA decreased/stable group had a trend toward better survival; however, the Log-rank test revealed no statistically significant difference in overall survival between groups (p = 0.068). This lack of significance may result from the small sample size or limited follow-up time, which could have reduced the ability to detect a meaningful effect. Still, the observed trend warrants further exploration and validation in larger prospective studies with longer follow-up. 3.5 Propensity Score Matching (PSM) analysis A 1:1 propensity score matching (PSM) analysis was performed between the two groups of patients undergoing radical resection to minimize the influence of demographic and perioperative information bias. A total of 64 patients were evaluated, with 32 patients in each group. After propensity score matching, no statistically significant differences were observed in any baseline characteristics between the groups with decreased/stable versus increased serum uric acid in the radical surgery group (Table 9 , p > 0.05). These characteristics included age, gender, BMI, history of underlying diseases, tumor histology, location, stage, and surgical approach. Furthermore, secondary outcome measures revealed no significant differences between the groups in terms of length of hospital stay, hospitalization costs, or incidence of postoperative complications, including pancreatic fistula, biliary fistula, bleeding, and intra-abdominal infection (Table 10 , p > 0.05). In summary, under conditions of balanced baseline characteristics, postoperative changes in serum uric acid levels did not significantly impact patients' short-term perioperative outcomes. Table 9 Demographics of the Uric Acid Decreased/Stable Group and the Uric Acid Increased Group After Propensity Score Matching (Radical Resection Group) Variables Group P- value Total (N = 64) Decreased/Stable SUA(N = 32) Increased SUA (N = 32) Age, years, mean ± SD 64.69 ± 10.64 62.66 ± 9.72 0.428 Gender, N (%) 0.302 Male 40(62.50) 18(56.25) 22(68.75) Female 24(37.50) 14(43.75) 10(31.25) BMI, kg/m 2 , mean ± SD 22.50 ± 3.33 22.31 ± 2.83 0.808 Hypertension, N(%) 14(21.86) 8(25.00) 6(18.75) 0.545 Diabetes, N(%) 19(29.69) 7(21.88) 12(37.50) 0.171 Smoking History, N(%) 33(51.56) 16(50.00) 17(53.12) 0.802 History of Alcohol Consumption, N(%) 21(32.81) 9(28.13) 12(37.50) 0.424 Pathological Subtyping, N(%) 0.313 Adenocarcinoma 63(98.44) 32(100.00) 31(96.88) Non-adenocarcinoma 1(1.56) 0(0.00) 1(3.12) Tumor location, N(%) 0.117 Head of pancreas 11(17.19) 8(25.00) 3(9.38) Pancreatic body and tail 8(12.50) 2(6.25) 6(18.75) Pancreatic 45(70.31) 22(68.75) 23(71.88) Neurovascular invasion, N(%) 31(48.44) 15(46.88) 16(50.00) 0.802 AJCC Staging, N(%) 1.000 1、2 52(81.25) 26(81.25) 26(81.25) 3 12(18.75) 6(18.75) 6(18.75) Type of Surgery, N(%) 1.000 Pancreaticoduodenectomy 56(87.50) 28(87.50) 28(87.50) Distal Pancreatectomy 8(12.50) 4(12.50) 4(12.50) Table 10 Secondary Outcome Measures in the Uric Acid Reduction/Stabilization Group and the Uric Acid Elevation Group After Propensity Score Matching (Radical Resection Group) Variables Group P- value Total (N = 64) Decreased/Stable SUA(N = 32) Increased SUA (N = 32) Length of hospital stay /D 25.63 ± 7.61 27.88 ± 8.97 0.283 Hospitalization Costs /× 10⁴ CNY 8.82 ± 2.25 9.61 ± 3.66 0.304 Pancreatic fistula, N(%) 22(34.38) 12(37.50) 10(31.25) 0.599 Biliary fistula, N(%) 2(3.12) 0(0.00) 2(6.25) 0.151 Bleeding, N(%) 5(7.81) 2(6.25) 3(9.38) 0.641 Intra-abdominal infection, N(%) 41(64.06) 19(59.38) 22(68.75) 0.434 3.6 Analysis of prognostic factors in the Radical Resection Group after propensity score matching Univariate Cox regression analysis of overall mortality in the radical resection group of the PSM cohort showed that SUA levels, pancreatic fistula, and neurovascular invasion were linked to survival time. Multivariate analysis identified SUA level (HR 4.558, 95% CI 2.145–9.685, p < 0.001) and neurovascular involvement (HR 2.490, 95% CI 1.229–5.044, p = 0.011) as independent prognostic factors affecting patient survival time (Table 11 ). Univariate Cox regression analysis of recurrence-free survival in the radical resection group found that BMI, SUA levels, pancreatic fistula, and neurovascular invasion were associated with recurrence time. Multivariate analysis showed that BMI (HR 1.227, 95% CI 1.094–1.375, p < 0.001), SUA level (HR 7.544, 95% CI 3.455–16.476, p < 0.001), pancreatic fistula (HR 0.384, 95% CI 0.186–0.794, p = 0.010), and neurovascular invasion (HR 2.171, 95% CI 1.102–4.277, p = 0.025) were independent risk factors impacting recurrence time (Table 12 ). Table 11 Cox Proportional Hazards Analysis of Overall Survival Prognosis Factors After Propensity Score Matching (Radical Resection Group) Variables Univariate Multivariate HR 95%CI P HR 95%CI P- value Age (increasing) 1.008 0.63–1.005 0.723 Sex, male (female ref.) 1.408 0.662–2.996 0.374 BMI (increasing) 0.098 0.951–1.280 0.193 AJCC III(I、II) 1.623 0.745–3.537 0.223 Surgical Approach, PD (DP) 1.657 0.651–4.222 0.290 Increased SUA (dec./stable SUA ref.) 5.412 1.935–15.139 0.001 4.558 2.145–9.685 < 0.001 Preoperative CA199(increasing) 1.000 0.999–1.001 0.702 Pancreatic fistula (positive) 0.296 0.103–0.854 0.024 0.466 0.213–1.022 0.057 Biliary fistula (positive) 0.995 - - Bleeding (positive) 4.170 0.893–19.467 0.069 Intra-abdominal infection (positive) 1.388 0.625–3.084 0.421 Neurovascular involvement (positive) 2.399 1.080–5.327 0.032 2.490 1.229–5.044 0.011 Preoperative Total Bilirubin (increasing) 0.997 0.993–1.003 0.103 Preoperative Direct Bilirubin (increasing) 0.998 0.993–1.003 0.473 Preoperative indirect bilirubin (increasing) 1.000 0.996–1.003 0.877 HR, Hazard Ratio Table 12 Cox Proportional Hazards Analysis of Prognostic Factors for Recurrence-Free Survival After Propensity Score Matching (Radical Resection Group) Variables Univariate Multivariate HR 95%CI P HR 95%CI P- value Age (increasing) 0.979 0.941–1.019 0.304 Sex, male (female ref.) 1.081 0.550–2.216 0.822 BMI (increasing) 1.164 1.015–1.335 0.029 1.227 1.094–1.375 < 0.001 AJCC III(I、II) 1.436 0.662–3.116 0.360 Surgical Approach, PD (DP) 1.377 0.627–3.023 0.416 Increased SUA (dec./stable SUA ref.) 4.571 1.798–11.621 0.0021 7.544 3.455–16.476 < 0.001 Preoperative CA199(increasing) 1.000 0.999–1.001 0.808 Pancreatic fistula (positive) 0.315 0.125–0.794 0.014 0.384 0.186–0.794 0.010 Biliary fistula (positive) 0.594 0.059–5.998 0.659 Bleeding (positive) 1.386 0.390–4.929 0.614 Intra-abdominal infection (positive) 1.377 0.627–3.023 0.426 Neurovascular involvement (positive) 2.599 1.244–5.430 0.011 2.171 1.102–4.277 0.025 Preoperative Total Bilirubin (increasing) 0.999 0.995–1.002 0.475 Preoperative Direct Bilirubin (increasing) 0.996 0.991–1.002 0.168 Preoperative indirect bilirubin (increasing) 1.043 0.987–1.103 0.136 HR, Hazard Ratio 4. Discussion In this study, the 3-year overall survival (OS) after resection of pancreatic cancer was 16.3%, significantly lower than previously reported conditional survival rates of 55% at 1 year and 74% at 3 years post-surgery [ 30 ] . This difference indicates that multiple factors influence long-term prognosis in pancreatic cancer. Cox regression analysis confirmed elevated serum uric acid (SUA) as an independent predictor of OS, consistent with existing evidence. Notably, a prospective UK Biobank cohort study by Huang et al. [ 25 ] (N = 444,462) showed that elevated SUA has gender-specific associations, increasing the risk of pancreatic cancer in women and gallbladder cancer in men. Furthermore, a clinical study involving 466 patients diagnosed with pancreatic ductal adenocarcinoma further confirmed that elevated SUA levels serve as a marker of poor prognosis in pancreatic cancer patients [ 31 ] . This association was validated in our study via Kaplan-Meier analysis: patients with decreased/stable SUA levels demonstrated significantly superior 3-year OS and RFS compared to those with elevated SUA levels (OS: 16.3% vs. 12.9%; RFS: 17.4% vs. 9.2%). Collectively, these findings indicate that SUA levels are closely associated with postoperative prognosis in pancreatic cancer, suggesting that active monitoring and control of SUA levels are clinically necessary to improve patient survival outcomes. Basic studies have shown that SUA promotes tumor growth through the xanthine oxidase (XOR)-COX-2 pathway [ 32 – 34 ] , providing a mechanistic explanation for its prognostic significance in pancreatic cancer. Ohtsubo et al. [ 33 ] demonstrated that SUA controls COX-2 via XOR, and Xie et al. [ 34 ] confirmed that COX-2 elevation encourages growth in pancreatic cancer cells—consistent with our clinical findings of worse outcomes associated with high SUA. Notably, low XOR may increase COX-2 levels to boost proliferation, while tumor cell death raises SUA, creating a vicious cycle [ 35 ] . Shin et al. [ 36 ] proposed SUA as a predictor of survival in advanced cancer, and Fini et al. [ 35 ] identified it as an independent risk factor for cancer development and death by aiding tumor transformation and growth. Additionally, high SUA triggers inflammatory stress and promotes cellular transformation inside cells, while extracellular SUA stimulates tumor cell growth, movement, and survival [ 30 ] . Therefore, monitoring SUA could help identify high-risk patients and enable early treatment. More research is needed to understand the role of SUA in the pancreatic cancer microenvironment and its potential for clinical use. The American Joint Committee on Cancer (AJCC) pathological staging system is the global standard for pancreatic cancer management. A study of 5,097 patients confirmed the 8th edition AJCC stage as an independent prognostic factor, with mortality risk increasing as the stage advances [ 37 ] . Consistently, we observed higher stages associated with worse overall survival (OS) and recurrence-free survival (RFS). However, limitations remain; an analysis of 45,856 patients showed varied survival rates within the same stage, indicating the need for better prognostic accuracy [ 38 ] . Incorporating new biomarkers may improve staging precision [ 39 ] . Notably, our subgroup analysis demonstrated that patients with stable or decreased SUA levels had better survival across all AJCC stages, suggesting that tracking changes in SUA could improve prognostic assessment and aid in more accurate clinical decision-making. Perineural invasion (PNI) is a key pathological feature of pancreatic ductal adenocarcinoma (PDAC), occurring more often than in other cancers [ 40 , 41 ] . It is defined as cancer cell invasion along or within nerve sheaths [ 42 ] and is linked to pain, recurrence, and lower survival rates. Molecularly, PNI involves cancer-produced neurotrophic factors (e.g., NGF, GDNF), chemokines (e.g., CCL2), and adhesion molecules (e.g., NCAM, L1CAM), which promote neural invasion and modify the tumor environment to support metastasis [ 40 ] . Our survival analysis confirms that neurovascular invasion predicts significantly worse overall and recurrence-free survival. Detecting PNI early may help guide clinical decisions, and targeting its molecular pathways offers a promising approach to improve prognosis. Postoperative pancreatic fistula (POPF), as defined by the ISGPS, involves drain amylase levels exceeding three times the upper normal serum level on or after postoperative day 3 [ 43 ] . POPF is graded as: Grade A (biochemical, asymptomatic); Grade B (requiring management such as antibiotics or nutritional support); or Grade C (necessitating primary intervention like drainage or reoperation) [ 43 ] . This study included only Grade A POPF, which had no significant clinical impact. Although previous research in 200 pancreatoduodenectomy patients indicated that Grade B/C POPF prolongs hospitalization without increasing mortality [ 44 ] , our propensity score-matched analysis revealed an association between POPF and recurrence-free survival. Given the limited sample size, further validation in larger prospective studies is needed to clarify the effect of POPF on long-term outcomes in pancreatic cancer. Both high and low BMI are linked to adverse outcomes after pancreatoduodenectomy. A study of 1,384 patients showed that obesity extends hospital stays and increases pancreatic cancer incidence and mortality [ 45 ] . Temraz S et al. [ 46 ] (N = 236) reported that preoperative weight loss and BMI over 30 raise postoperative complication risks, emphasizing the importance of nutritional support and weight management. Conversely, a study of 329 patients found that BMI < 25 is associated with worse overall survival [ 47 ] . Although our Cox regression did not identify BMI as a significant factor for overall survival, it revealed a statistically significant link with recurrence-free survival. These consistent findings underscore the clinical importance of maintaining an appropriate BMI, although the molecular mechanisms need further investigation. In the PSM cohort analysis, elevated SUA and neurovascular invasion remained independent risk factors for overall survival (P < 0.05) after adjusting for confounders. These findings support incorporating SUA management into comprehensive pancreatic cancer care. Preoperative SUA screening should be performed, with urate-lowering therapy (e.g., allopurinol or febuxostat) considered for elevated levels. Postoperative monitoring and control of SUA (increase < 10%) may help reduce recurrence risk. Perioperative strategies should also include nutritional support for underweight or cachectic patients [ 45 , 46 ] and weight management for those with obesity (BMI ≥ 30) [ 46 ] . As a modifiable factor, SUA is a potential target for standardized follow-up and intervention. Prospective studies are needed to assess its impact on survival. Painless jaundice is a common presentation in pancreatic head adenocarcinoma. Preoperative jaundice has been identified as an independent negative prognostic factor [ 48 ] . Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred method for preoperative biliary drainage, with endoscopic ultrasound-guided (EUS-BD) or percutaneous transhepatic drainage (PTBD) as alternatives if ERCP fails [ 49 ] . Preoperative ERCP stent placement is associated with significantly improved survival (HR = 0.59, 95% CI 0.41–0.85, P = 0.005) [ 48 ] . Alternative approaches, such as hepaticogastrostomy (HGS) or choledochoduodenostomy (CDS), may be considered when cannulation is unsuccessful [ 50 ] . Although no significant difference was observed in the palliative group in this study—possibly due to sample size limitations—multiple studies support preoperative biliary drainage to improve survival in jaundiced patients. This study offers the first systematic analysis connecting serum uric acid (SUA) levels to postoperative outcomes in pancreatic cancer. Key methodological strengths include thorough adjustment for risk factors and the use of propensity score matching (PSM) to minimize confounding. Elevated SUA remained significantly linked to worse survival even after multivariate adjustment. However, some limitations must be noted. First, although PSM accounted for known confounders, the retrospective design still risks selection bias and unmeasured variables. Second, the clinical data do not provide mechanistic insight into how SUA impacts pancreatic cancer progression. Future research should focus on: 1) prospective cohorts with standardized SUA measurement protocols to confirm these results; and 2) interventional trials testing whether perioperative urate-lowering therapies (such as allopurinol) enhance surgical outcomes. If these findings are validated, SUA monitoring could be integrated into existing prognostic models like AJCC staging to improve risk stratification. Additionally, metabolic optimization (including SUA control) may serve as a valuable addition to the multidisciplinary management of pancreatic cancer. 5. Conclusions This cohort study identifies elevated serum uric acid (SUA) as an independent predictor of adverse postoperative outcomes in resected pancreatic cancer patients, supporting its potential use as a prognostic biomarker. Monitoring and managing SUA around the time of surgery may help with risk assessment and guide personalized treatment plans. These findings require validation through larger, prospective multicenter studies, and more mechanistic research is necessary to understand the biological pathways linking SUA to pancreatic cancer progression. Abbreviations AJCC, American Joint Committee on Cancer BRPC, borderline resectable pancreatic cancer BMI, body mass index CDS, choledochoduodenostomy ERCP, endoscopic retrograde cholangiopancreatography EUS-BD, endoscopic ultrasound-guided HGS, hepaticogastrostomy LAPC, locally advanced pancreatic cancer OS, overall survival PRPC, primary resectable pancreatic cancer PSM, propensity score matching PNI, perineural invasion PDAC, pancreatic ductal adenocarcinoma POPF, postoperative pancreatic fistula PTBD, percutaneous transhepatic drainage RFS, recurrence-free survival XOR, xanthine oxidase Declarations Acknowledgments Thanks to Shen Cheng, Chenyang Wei, Pengfei Li, Ping Yue, Yanyan Lin, Long Gao, and Wenbo Meng. Author Contributions Zhengping, An: Conceptualization; Methodology; Data Curation; Writing–Original Draft; Writing–Review and Editing. Sheng, Chen: Investigation; Data Curation. Chenyang, Wei: Investigation; Data Curation. Pengfei, Li: Investigation; Data Curation. Ping, Yue: Writing–Review and Editing; Project Administration. Yanyan, Lin: Writing–Review and Editing; Project Administration. Long, Gao: Conceptualization; Supervision; Writing–Review and Editing; Funding Acquisition. Wenbo, Meng: Conceptualization; Supervision; Writing–Review and Editing; Funding Acquisition. Competing interests The authors declare no potential conflicts of interest. Funding information This study was supported by the National Natural Science Foundation of China (82560492) and the National Key Research and Development Program of China (2022YFC2407405). The funders had no role in the study design, data collection, analysis, interpretation, manuscript writing, or the decision to submit the manuscript for publication. Data Availability Statement The data for this study were obtained from the First Hospital of Lanzhou University. The study was registered with ClinicalTrials.gov on July 21, 2025. The registration number is NCT07091526. Additional information is available from the corresponding author upon request. Ethics approval and consent to participate All patients provided informed consent. This study complies with the Declaration of Helsinki and was approved by the Ethics Committee of the First Hospital of Lanzhou University. References Characteristics. and outcomes of pancreatic cancer by histological subtypes – PubMed [EB/OL]. [2025-04-15]. https://pubmed.ncbi.nlm.nih.gov/31210663/ SIEGEL R L, GIAQUINTO A N JEMALA. Cancer statistics, 2024[J]. Cancer J Clin. 2024;74(1):12–49. SIEGEL R L SUNGH. Global patterns in excess body weight and the associated cancer burden[J]. Cancer J Clin. 2019;69(2):88–112. HUGHES T, HARPER A, GUPTA S, et al. The current and future global burden of cancer among adolescents and young adults: A population-based study[J]. Lancet Oncol. 2024;25(12):1614–24. SIEGEL R L SUNGH, ROSENBERG PS, et al. Emerging cancer trends among young adults in the USA: Analysis of a population-based cancer registry[J]. Lancet Public Health. 2019;4(3):e137–47. HUANG L, JANSEN L, BALAVARCA Y, et al. Resection of pancreatic cancer in europe and USA: An international large-scale study highlighting large variations[J]. Gut. 2019;68(1):130–9. MACKAY TM, VAN ERNING F N, VAN DER GEEST L G, M et al. Association between primary origin (head, body and tail) of metastasised pancreatic ductal adenocarcinoma and oncologic outcome: A population-based analysis[J]. European Journal of Cancer (Oxford, England: 1990), 2019, 106: 99–105. STOOP T F, THEIJSE R T, SEELEN L W F, et al. Preoperative chemotherapy, radiotherapy, and surgical decision-making in patients with borderline resectable and locally advanced pancreatic cancer[J]. Nat Rev Gastroenterol Hepatol. 2024;21(2):101–24. CONROY T, PFEIFFER P. Pancreatic cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up[J]. Annals Oncology: Official J Eur Soc Med Oncol. 2023;34(11):987–1002. LIAO W C, CHIEN K L, LIN Y L, et al. Adjuvant treatments for resected pancreatic adenocarcinoma: A systematic review and network meta-analysis[J]. Lancet Oncol. 2013;14(11):1095–103. VAN GOOR I W J M, SCHOUTEN T J, VERBURG D N, et al. Predicting long-term disease-free survival after resection of pancreatic ductal adenocarcinoma: A nationwide cohort study[J]. Ann Surg. 2024;279(1):132–7. DORLAND DAAMENLA, BRADA L J H G, et al. Preoperative predictors for early and very early disease recurrence in patients undergoing resection of pancreatic ductal adenocarcinoma[J]. HPB: official J Int Hepato Pancreato Biliary Association. 2022;24(4):535–46. BENGTSSON A, ANDERSSON R. The actual 5-year survivors of pancreatic ductal adenocarcinoma based on real-world data[J]. Sci Rep. 2020;10(1):16425. TEMPERO M A, MALAFA M P, AL-HAWARY M, et al. Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw. 2017;15(8):1028–61. SÁNCHEZ-VELÁZQUEZ P, MULLER X. Benchmarks in pancreatic surgery: A novel tool for unbiased outcome comparisons[J]. Ann Surg. 2019;270(2):211–8. DURIN T, MARCHESE U. Defining benchmark outcomes for distal pancreatectomy: Results of a French multicentric study[J]. Ann Surg. 2023;278(1):103–9. LOOS M, AL-SAEEDI M, HINZ U, et al. Categorization of differing types of total pancreatectomy[J]. JAMA Surg. 2022;157(2):120–8. Early detection of. pancreatic cancer - PubMed [EB/OL]. [2025-04-16]. https://pubmed.ncbi.nlm.nih.gov/32135127/ JIANG M, GONG D, FAN Y. Serum uric acid levels and risk of prehypertension: A meta-analysis[J]. Clin Chem Lab Med. 2017;55(3):314–21. Regulation of uric acid. metabolism and excretion - PubMed[EB/OL]. [2025-04-17]. https://pubmed.ncbi.nlm.nih.gov/26316329/ GRIEBSCH A, ZÖLLNER N. Effect of ribomononucleotides given orally on uric acid production in man[J]. Adv Exp Med Biol. 1974;41:443–9. KÜHN T, SOOKTHAI D, GRAF M E, et al. Albumin, bilirubin, uric acid and cancer risk: Results from a prospective population-based study[J]. Br J Cancer. 2017;117(10):1572–9. LAWAL A O KOLUDEB. ADEYEMI B F. Serum uric acid levels in oral cancer patients seen at tertiary institution in nigeria[J]. Annals Ib Postgrad Med. 2012;10(1):9–12. BENLI E, CIRAKOGLU A, AYYILDIZ S N, et al. Comparison of serum uric acid levels between prostate cancer patients and a control group[J]. Cent Eur J Urol. 2018;71(2):242–7. STRASAK AM, RAPP K, HILBE W, et al. The role of serum uric acid as an antioxidant protecting against cancer: Prospective study in more than 28 000 older austrian women[J]. Annals Oncology: Official J Eur Soc Med Oncol. 2007;18(11):1893–7. HUANG C F, HUANG J J, MI N N, et al. Associations between serum uric acid and hepatobiliary-pancreatic cancer: A cohort study[J]. World J Gastroenterol. 2020;26(44):7061–75. YAN S, ZHANG P, XU W et al. Serum uric acid increases risk of cancer incidence and mortality: A systematic review and meta-analysis[J]. Mediators of Inflammation, 2015, 2015: 764250. RICÓS C, ALVAREZ V, CAVA F. Current databases on biological variation: Pros, cons and progress[J]. Scand J Clin Lab Investig. 1999;59(7):491–500. YIM K, BINDAYI A, MCKAY R, et al. Rising serum uric acid level is negatively associated with survival in renal cell carcinoma[J]. Cancers. 2019;11(4):536. FOR THE DUTCH PANCREATIC CANCER GROUP, LATENSTEIN A E J, VAN ROESSEL S, et al. Conditional survival after resection for pancreatic cancer: A population-based study and prediction model[J]. Ann Surg Oncol. 2020;27(7):2516–24. STOTZ M, SZKANDERA J, SEIDEL J, et al. Evaluation of uric acid as a prognostic blood-based marker in a large cohort of pancreatic cancer patients[J]. PLoS ONE. 2014;9(8):e104730. HILLE R. Molybdenum-containing hydroxylases[J]. Arch Biochem Biophys. 2005;433(1):107–16. OHTSUBO T, ROVIRA I I, STAROST M F, et al. Xanthine oxidoreductase is an endogenous regulator of cyclooxygenase-2[J]. Circul Res. 2004;95(11):1118–24. XIE C, XU X, WANG X et al. Cyclooxygenase–2 induces angiogenesis in pancreatic cancer mediated by prostaglandin E2[J/OL]. Oncology Letters, 2018[2025-08-11]. http://www.spandidos-publications.com/ 10.3892/ol.2018.8786 FINI MA, JOHNSON R J ELIASA, et al. Contribution of uric acid to cancer risk, recurrence, and mortality[J]. Clin Translational Med. 2012;1(1):e16. SHIN HS, LEE H R, LEE D C, et al. Uric acid as a prognostic factor for survival time: A prospective cohort study of terminally ill cancer patients[J]. J Pain Symptom Manag. 2006;31(6):493–501. LI C, REN Z. A prognostic nomogram for pancreatic ductal adenocarcinoma patients’ all-cause survival in a surveillance, epidemiology, and end results analysis[J]. Translational Cancer Res. 2020;9(5):3586–99. SHI S, HUA J, LIANG C, et al. Proposed modification of the 8th edition of the AJCC staging system for pancreatic ductal adenocarcinoma[J]. Ann Surg. 2019;269(5):944–50. VAN ROESSEL S, KASUMOVA G G, VERHEIJ J, et al. International validation of the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system in patients with resected pancreatic cancer[J]. JAMA Surg. 2018;153(12):e183617. GASPARINI G, PELLEGATTA M. Nerves and pancreatic cancer: New insights into a dangerous relationship[J]. Cancers. 2019;11(7):893. LIEBL F, DEMIR I E, MAYER K, et al. The impact of neural invasion severity in gastrointestinal malignancies: A clinicopathological study[J]. Ann Surg. 2014;260(5):900–8. DEMIR I E, CEYHAN G O, LIEBL F, et al. Neural invasion in pancreatic cancer: The past, present, and future[J]. Cancers. 2010;2(3):1513–27. BASSI C, DERVENIS C, BUTTURINI G, et al. Postoperative pancreatic fistula: An international study group (ISGPF) definition[J]. Surgery. 2005;138(1):8–13. ENDERES J, PILLNY C, MATTHAEI H, et al. Clinically relevant pancreatic fistula after pancreaticoduodenectomy: How we do it[J]. Biology. 2023;12(2):178. PERRONE V G, IACOPI S, AMORESE G, et al. Impact of nutritional status on outcome of pancreatic resections for pancreatic cancer and periampullary tumors[J]. Hepatobiliary Surg Nutr. 2020;9(5):669–72. TEMRAZ S, CHARAFEDDINE M. Pre-operative markers of post-operative complications in pancreatic cancer patients: A single-center study[J]. J Epidemiol Global Health. 2025;15(1):28. CUI L, YU H, SUN Q, et al. Effects of body mass index and serum albumin on overall survival in patients with cancer undergoing pancreaticoduodenectomy: A single-center retrospective cohort study[J]. World J Surg Oncol. 2022;20(1):221. STRASBERG SM, GAO F, SANFORD D, et al. Jaundice: An important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas[J]. HPB. 2014;16(2):150–6. NEHME F, LEE JH. Preoperative biliary drainage for pancreatic cancer[J]. Dig Endoscopy. 2022;34(3):428–38. MAZUR R, TRNA J. Principles of palliative and supportive care in pancreatic cancer: A review[J]. Biomedicines. 2023;11(10):2690. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 24 Mar, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers invited by journal 16 Mar, 2026 Editor invited by journal 06 Mar, 2026 Editor assigned by journal 05 Mar, 2026 Submission checks completed at journal 05 Mar, 2026 First submitted to journal 02 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. 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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-9008446","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607412419,"identity":"1eba3b71-df27-4a02-81af-38282766c023","order_by":0,"name":"zhengping an","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"zhengping","middleName":"","lastName":"an","suffix":""},{"id":607412420,"identity":"466d110c-aee2-439a-af2d-b42e1eb59341","order_by":1,"name":"shen chen","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"shen","middleName":"","lastName":"chen","suffix":""},{"id":607412421,"identity":"20f53a44-0ed9-4808-ae84-fbbcfc6ebf21","order_by":2,"name":"chenyanng wei","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"chenyanng","middleName":"","lastName":"wei","suffix":""},{"id":607412422,"identity":"df45d6d6-9cc7-44e8-91df-e5df15feecce","order_by":3,"name":"pengfei li","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"pengfei","middleName":"","lastName":"li","suffix":""},{"id":607412423,"identity":"b98de5a1-f777-40c4-a4d0-d971f23836f7","order_by":4,"name":"ping yue","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"ping","middleName":"","lastName":"yue","suffix":""},{"id":607412424,"identity":"9bc9e16e-f543-42d7-8768-7b616bb282b6","order_by":5,"name":"yanyan lin","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"yanyan","middleName":"","lastName":"lin","suffix":""},{"id":607412425,"identity":"21ed4601-2eea-478d-aebb-489167cbee1a","order_by":6,"name":"long gao","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"long","middleName":"","lastName":"gao","suffix":""},{"id":607412426,"identity":"634569d0-1a22-48b9-a55f-0d4eebd9e4d6","order_by":7,"name":"wenbo meng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYLACxgYbGTCDhwQtaTwkazlMghbd9t7Dr3l3nOeRn5HA+OBtG4O8OSEtZmfOpVnznrnNwzgjgdlwbhuD4c4GQlpu5JgZ57bd5mGWSGCT5m1jSDA4QEjL/TcgLed42CQS2H8Tp+UGj/Hj3LYDPDxAW5iJ03Imx4z575lkHgmeh82Sc85JGG4gqOX4GeOPM3fYycm3Jx/88KbMRp6gLUDAJgGhGRuAhARh9UDA/IEoZaNgFIyCUTByAQBojjv/kKg5TAAAAABJRU5ErkJggg==","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":true,"prefix":"","firstName":"wenbo","middleName":"","lastName":"meng","suffix":""}],"badges":[],"createdAt":"2026-03-02 09:41:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9008446/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9008446/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104993662,"identity":"ae07f777-50e0-4cba-ba84-42642e98623f","added_by":"auto","created_at":"2026-03-19 15:56:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":150999,"visible":true,"origin":"","legend":"\u003cp\u003eInclusion/Exclusion Criteria Flowchart\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-9008446/v1/3e8b98bead6204747a77c5dc.png"},{"id":104993642,"identity":"43df0c98-fe6b-420d-820c-a350445f96b2","added_by":"auto","created_at":"2026-03-19 15:56:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":246772,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative Survival Rate for Pancreatic Cancer in the Radical Resection Group. (A) Kaplan-Meier survival curves for overall survival in the uric acid stabilization/reduction group and the uric acid elevation group (P\u0026lt;0.001, Log-Rank test); (B) Kaplan-Meier survival curves for recurrence-free survival in the uric acid stabilization/reduction group and the uric acid elevation group (P\u0026lt;0.001, Log-Rank test).\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-9008446/v1/ff4f80c2f07bd262a48c0985.png"},{"id":104993778,"identity":"693df425-e1c5-4691-8134-d3bb874ffb44","added_by":"auto","created_at":"2026-03-19 15:57:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":397465,"visible":true,"origin":"","legend":"\u003cp\u003eSurvival curves for different AJCC stages in the Radical Resection Group. (A) Cumulative survival rate for AJCC I (P=0.359, Log-Rank test); (B) Cumulative survival rate for AJCC II (P=0.0036, Log-Rank test); (C) Cumulative survival rate for AJCC Stage I (P\u0026lt;0.001, Log-Rank test).\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-9008446/v1/6a7bc9f812073b92d35453ab.png"},{"id":104993769,"identity":"394fc717-5da6-4966-8148-6aa0df8b1216","added_by":"auto","created_at":"2026-03-19 15:57:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":394097,"visible":true,"origin":"","legend":"\u003cp\u003eRecurrence-free survival curves for various AJCC stages. (A) Cumulative survival rate for AJCC I (P=0.643, Log-Rank test); (B) Cumulative survival rate for AJCC II (P=0.012, Log-Rank test); (C) Cumulative survival rate for AJCC Stage III (P\u0026lt;0.001, Log-Rank test).\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-9008446/v1/3774a2415ca392fcc468a893.png"},{"id":104993666,"identity":"61be87cc-48a3-445c-ad6b-01302f81a44a","added_by":"auto","created_at":"2026-03-19 15:56:41","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":275704,"visible":true,"origin":"","legend":"\u003cp\u003eCumulative survival rates across different AJCC stages in the Radical Resection Group. (A) Kaplan-Meier survival curves for overall survival in various AJCC stages (P=0.008, Log-Rank test); (B) Kaplan-Meier survival curves for recurrence-free survival in various AJCC stages (P=0.1278, Log-Rank test).\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-9008446/v1/4436fe248a9b5e0147887a6b.png"},{"id":104993771,"identity":"476ce7bb-7848-47cf-be58-47eaed3b1d24","added_by":"auto","created_at":"2026-03-19 15:57:00","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":180394,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curves for overall survival in the uric acid stabilization/reduction group and the uric acid elevation group (Palliative Treatment Group)\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-9008446/v1/b3045fb53ab0003af1eccf46.png"},{"id":104993816,"identity":"3154c82e-3082-403e-9585-d04c519172d7","added_by":"auto","created_at":"2026-03-19 15:57:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3468274,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9008446/v1/be9c1406-44cb-458e-85ff-417303033e88.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Role of Serum Uric Acids in Protecting Postoperative Survival in Pancreatic Cancer","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePancreatic cancer is the most common solid tumor of the pancreas, accounting for over 95% of all pancreatic tumors \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. This disease exhibits highly aggressive biological features and often presents with subtle early symptoms. The median survival is about 4 months, with a 5-year survival rate of 13% \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Notably, incidence rates among younger individuals (15\u0026ndash;39 years old) have increased in recent years, with a global age-standardized incidence rate of 0.2% \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. This trend may be linked to the rising prevalence of obesity \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Epidemiological data show that approximately 57% of pancreatic cancer patients already have metastasis at diagnosis \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Metastases mainly occur in the liver (75\u0026ndash;80%), peritoneum (13\u0026ndash;30%), lungs (15\u0026ndash;18%), and extra-regional lymph nodes (12%) \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFor pancreatic cancer without metastasis, resectability mainly depends on the involvement of key peripancreatic vessels, including the superior mesenteric artery, celiac trunk, hepatic artery branches, and portal vein axis. These are classified into three categories: Primary Resectable Pancreatic Cancer (PRPC), Borderline Resectable Pancreatic Cancer (BRPC), and Locally Advanced Pancreatic Cancer (LAPC) \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. In current treatment strategies, palliative chemotherapy is the standard approach for metastatic pancreatic cancer \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. For localized pancreatic cancer, surgical resection combined with adjuvant chemotherapy is recommended \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, providing patients with the best chance for long-term survival. However, high postoperative recurrence rates\u0026mdash;reaching 48% at 12 months and 86% at 5 years \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e\u0026mdash;result in a 5-year overall survival rate of only 17% after curative resection \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFor patients with resectable or borderline resectable pancreatic cancer, radical surgery is performed. For those with advanced pancreatic cancer, such as cases involving biliary obstruction, palliative treatment is primarily used \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Curative surgery typically involves pancreaticoduodenectomy as the primary procedure \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, followed by distal pancreatectomy (i.e., pancreatic body-tail resection) \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e and total pancreatectomy \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. However, treating pancreatic cancer remains difficult. First, there is a lack of practical screening tools to identify high-risk populations \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Second, reliable factors for predicting long-term survival are minimal \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eUric acid, as the end product of purine metabolism \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, is primarily processed through renal and intestinal pathways \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. At physiological pH, this weak acid (pKa 5.8) mainly exists as urate \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Current research shows that low serum uric acid levels are a risk factor for various cancers \u003csup\u003e[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. K\u0026uuml;hn et al. found that uric acid levels inversely correlate with breast cancer risk (HR: 0.72, 95% CI: 0.53\u0026ndash;0.99) and cancer mortality (HR: 0.75, 95% CI: 0.58\u0026ndash;0.98), suggesting that higher SUA levels may serve as a useful prognostic marker for breast cancer patients \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. However, other studies indicate that elevated SUA levels could increase cancer mortality risk \u003csup\u003e[\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Strasak et al. \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e examined the relationship between SUA and antioxidant/protective effects against cancer in a large cohort of 28,613 elderly Austrian women. Their findings contradicted the antioxidant/protective hypothesis, implying that elevated SUA levels might reflect poor prognosis. Yan et al. \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e demonstrated through a meta-analysis that higher SUA levels raise the risk of overall cancer incidence and mortality, challenging the idea of SUA's protective role in cancer. Huang et al. \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e in a prospective cohort study involving 444,462 participants from the UK Biobank, proposed that SUA has a sex-specific impact on hepatobiliary and pancreatic cancers, with elevated SUA levels being risk factors for pancreatic cancer in women and gallbladder cancer in men. Nonetheless, the connection between SUA levels and postoperative outcomes in pancreatic cancer patients remains unclear. Therefore, this retrospective study aims to analyze SUA level trends over time in pancreatic cancer patients and systematically evaluate the potential relationship between SUA levels and postoperative clinical outcomes.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and participants\u003c/h2\u003e \u003cp\u003eThis is a single-center, retrospective cohort study designed to determine whether controlling serum uric acid levels offers postoperative survival benefits for patients with pancreatic cancer. Patients provided informed consent before surgery. This study adheres to the Declaration of Helsinki and is registered on clinicaltrials.gov (NCT07091526). It was approved by the Ethics Committee of the First Hospital of Lanzhou University.\u003c/p\u003e \u003cp\u003eBased on previous studies, we defined \"Increased\" serum uric acid (SUA) as a postoperative increase of more than 10% compared to preoperative levels. At the same time, all other values were classified as \"Decreased/Stable\" \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e][\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. This study collected data from 815 patients admitted to the First Hospital of Lanzhou University between 2016 and 2024 with a diagnosis of pancreatic malignancy. Among these, 198 cases were included. Exclusion criteria were: patients who did not undergo surgical treatment, those who received emergency hemodialysis or plasma exchange after surgery, patients with gout or a history of long-term urate-lowering therapy (e.g., allopurinol), patients lacking follow-up data, and patients with non-pancreatic primary tumors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data collection\u003c/h2\u003e \u003cp\u003eExtract clinical data from electronic medical records. Patient demographics include age, gender, body mass index (BMI), smoking history, alcohol consumption history, diabetes, and hypertension. Laboratory tests include total bilirubin, direct bilirubin, indirect bilirubin, uric acid, and CA199. Intraoperative details include the surgical approach, tumor location, and neurovascular invasion. Record postoperative complications such as pancreatic fistula, biliary fistula, postoperative hemorrhage, and intra-abdominal infection. Document perioperative information, including the surgical approach, tumor location, neurovascular invasion, postoperative pathological staging (TNM), length of hospital stay, and hospitalization costs. After recording all subjects' baseline information, subsequent researchers will verify and confirm that there are no default entries before completing the subject registration form.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Outcomes\u003c/h2\u003e \u003cp\u003eThe primary outcomes of this study are overall survival and recurrence-free survival, with follow-up continuing through August 2024. Overall survival is the time from surgical treatment to death from any cause; recurrence-free survival is the time from treatment to tumor recurrence or death. Secondary outcomes include length of hospital stay, hospitalization costs, and postoperative complications such as pancreatic fistula, biliary fistula, hemorrhage, and intra-abdominal infection. Based on the results of postoperative whole-abdominal contrast-enhanced CT scans, assist in determining and accurately documenting cancer recurrence and metastasis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e \u003cp\u003eFor data showing characteristics of quantitative information and following a normal distribution, the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s) was used for description. For categorical data, frequency (N) and percentage (%) were used. Categorical variables were analyzed with chi-square tests. Univariate logistic regression models identified potential factors associated with postoperative complications. Variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate analysis were included in multivariate logistic regression models to determine independent risk factors. Multiple linear regression models analyzed factors affecting postoperative length of stay and hospitalization costs, examining the impact of multiple variables on continuous outcomes. Univariate and multivariate analyses were performed using Cox proportional hazards regression models to evaluate factors influencing patient survival. Kaplan-Meier survival curves were plotted, and differences between groups were compared with the log-rank test. All statistical tests were two-sided, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as the threshold for significance. Data analysis was conducted using SPSS Statistics version 26, and graphical representations were created with GraphPad Prism 10.0.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1Baseline and perioperative characteristics\u003c/h2\u003e \u003cp\u003eA retrospective analysis was performed on 815 patients diagnosed with pancreatic malignancies from 2016 to 2024. After screening, 617 patients were excluded from the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The remaining 198 patients were divided into two groups based on the surgical approach and further categorized according to the degree of postoperative SUA increase: the SUA elevation group (n\u0026thinsp;=\u0026thinsp;119, 70.8%) and the SUA decrease/stable group (n\u0026thinsp;=\u0026thinsp;49, 29.2%). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays the baseline and perioperative characteristics of patients in the radical resection group. Significant differences were observed between the groups in alcohol history, tumor location, surgical type, preoperative SUA, and postoperative SUA. No significant differences were noted in other characteristics (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among patients receiving palliative treatment, the SUA elevation group included 20 patients (66.67%), while the SUA decrease/stability group comprised 10 patients (33.33%). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the baseline and perioperative characteristics of patients in the palliative treatment group. No statistically significant differences were identified between the groups regarding any baseline or perioperative characteristics (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eDemographics of the Uric Acid Reduction/Stabilization Group and Uric Acid Elevation Group Based on Propensity Score Matching (Radical Resection Group)\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=\"char\" char=\".\" 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 \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 \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDecreased/Stable SUA2(N\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased SUA\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;119)\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, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.98\u0026thinsp;\u0026plusmn;\u0026thinsp;10.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.24\u0026thinsp;\u0026plusmn;\u0026thinsp;12.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102 (60.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(67.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(57.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66 (39.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(32.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(42.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38(22.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(16.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(25.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.211\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43(25.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(22.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(26.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking History, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85(50.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(48.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61(51.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of Alcohol Consumption, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49(29.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(46.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(21.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathological Subtyping, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164(97.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115(96.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(3.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead of pancreas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34(20.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(20.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(20.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic body and tail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30(17.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(6.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27(22.69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104(61.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(73.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(57.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurovascular invasion, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83(49.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(55.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56(47.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAJCC Staging, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1、2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142(84.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(81.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102(85.72)\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\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26(15.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(18.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(14.28)\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\u003eType of Surgery, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreaticoduodenectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e133(79.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(91.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88(73.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal Pancreatectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35(20.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(8.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(26.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI, Body Mass Index; AJCC, American Joint Committee on Cancer\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \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\u003eDemographics of the Uric Acid Reduction/Stabilization Group and the Uric Acid Elevation Group (Palliative Care Group)\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=\"char\" char=\".\" 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 \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 \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDecreased/Stable SUA(N\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased SUA\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;20)\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, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.50\u0026thinsp;\u0026plusmn;\u0026thinsp;12.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.90\u0026thinsp;\u0026plusmn;\u0026thinsp;8.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (66.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(60.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(70.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(30.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.824\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(16.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(20.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(30.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(30.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(30.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking History, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(13.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(15.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.704\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of Alcohol Consumption, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the secondary outcome measures in the Radical Resection Group; there were no significant differences between the two groups in hospital stay length, hospitalization costs, or the rate of postoperative complications, including pancreatic fistula, biliary fistula, bleeding, and intra-abdominal infection (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Changes in serum uric acid levels after surgery did not significantly impact short-term perioperative results.\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\u003eSecondary Outcome Measures in the Uric Acid Reduction/Stabilization Group and the Uric Acid Elevation Group Before Propensity Score Matching (Radical Resection Group)\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=\"char\" char=\".\" 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 \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 \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDecreased/Stable SUA(N\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased SUA\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay /D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.53\u0026thinsp;\u0026plusmn;\u0026thinsp;9.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization Costs /\u0026times; 10⁴ CNY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.39\u0026thinsp;\u0026plusmn;\u0026thinsp;3.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic fistula, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67(39.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(32.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51(42.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiliary fistula, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(2.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(3.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.967\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(6.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(4.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(7.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-abdominal infection, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83(49.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(48.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59(49.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Survival situation\u003c/h2\u003e \u003cp\u003eIn the radical resection group, the decreased/stable subgroup showed a significantly longer median OS (18.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.467 months vs. 8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.898 months; HR, 2.508; 95% CI 1.645\u0026ndash;3.823; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). This group also experienced a notably better median RFS (16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.027 months compared to 7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.550 months; HR, 2.486; 95% CI 1.565\u0026ndash;3.951; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). In the palliative treatment group, the survival difference between the two cohorts did not reach statistical significance (HR, 3.589; 95% CI 0.793\u0026ndash;16.245; p\u0026thinsp;=\u0026thinsp;0.0684, Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere was no statistically significant difference in overall survival (OS) between patients with AJCC stage I disease in the radical resection group (16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.944 months vs. 0.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.000 months; HR, 1.443; 95% CI 0.643\u0026ndash;3.239; p\u0026thinsp;=\u0026thinsp;0.359; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). Similarly, no significant difference was observed in RFS (12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.078 months vs. 8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.502 months; HR, 2.021; 95% CI 1.002\u0026ndash;4.076; p\u0026thinsp;=\u0026thinsp;0.643, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA). Among patients undergoing radical resection for AJCC stage II disease, median overall survival was better in the group with decreased or stable SUA levels compared to the group with elevated levels (18.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.365 months vs. 5.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.723 months; HR, 2.656; 95% CI 1.306\u0026ndash;5.401; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB). Median recurrence-free survival was also longer in the decreased or stable group than in the increased group (16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.258 months vs. 4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.018 months; HR, 2.224; 95% CI 1.188\u0026ndash;4.164; p\u0026thinsp;=\u0026thinsp;0.012, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB). Among patients undergoing radical resection for AJCC Stage III disease, median overall survival was better in the group with decreased or stable SUA levels compared to the group with elevated levels (24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.493 months vs. 2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.376 months; HR, 6.559; 95% CI 2.029\u0026ndash;21.198; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC). Median recurrence-free survival was also longer in the decreased/stable group compared to the increased group (24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.442 months vs. 1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.000 months; HR, 5.783; 95% CI 1.810\u0026ndash;18.480; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003eSurvival analysis of 168 patients in the radical resection group, stratified by AJCC stage, showed significant differences in overall survival rates among stages I, II, and III (p\u0026thinsp;=\u0026thinsp;0.008, Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA), although no statistically significant difference was observed in recurrence-free survival (p\u0026thinsp;=\u0026thinsp;0.1278; Figs.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eB).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Analysis of prognostic factors in the Radical Resection Group before propensity score matching\u003c/h2\u003e \u003cp\u003eIn the radical resection group, univariate analysis showed that AJCC stage III (OR 8.786, 95% CI 2.0920\u0026ndash;36.905, p\u0026thinsp;=\u0026thinsp;0.003) and postoperative hemorrhage (OR 7.959, 95% CI 1.262\u0026ndash;50.193, p\u0026thinsp;=\u0026thinsp;0.027) were linked to overall mortality. Multivariate analysis further confirmed that AJCC stage III (OR 7.440, 95% CI 2.127\u0026ndash;26.027, p\u0026thinsp;=\u0026thinsp;0.002) was an independent predictor of overall mortality (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Cox regression analysis identified that AJCC stage III, elevated SUA levels, postoperative bleeding, neurovascular involvement, increased preoperative total bilirubin, and higher preoperative direct bilirubin levels were associated with overall survival (OS). Subsequently, multivariate Cox proportional hazards analysis demonstrated that AJCC stage III (HR 2.225, 95% CI 1.359\u0026ndash;3.641, p\u0026thinsp;=\u0026thinsp;0.001), elevated SUA levels (HR 3.004, 95% CI 0.994\u0026ndash;0.999, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and neurovascular invasion (HR 2.456, 95% CI 1.574\u0026ndash;3.834, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were independent prognostic factors affecting patient survival (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk Factors for Overall Mortality in Univariate and Multivariate Regression Analysis (Radical Resection Group)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.639\u0026ndash;2.673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male (female ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.972\u0026ndash;1.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.892\u0026ndash;1.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAJCC III(I、II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.0920\u0026ndash;36.905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.127\u0026ndash;26.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Approach, PD (DP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.475\u0026ndash;3.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.269\u0026ndash;1.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiliary fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.050\u0026ndash;3.951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.262\u0026ndash;50.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.695\u0026ndash;17.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-abdominal infection (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.331\u0026ndash;1.585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased SUA (dec./stable SUA ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.290\u0026ndash;1.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CA199(increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.999\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurovascular involvement (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.860\u0026ndash;3.659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Total Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.996\u0026ndash;1.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Direct Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.992\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative indirect bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.994\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eOR, Odds Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox Proportional Hazards Analysis of Overall Survival Prognostic Factors Before Propensity Score Matching (Radical Resection Group)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.980\u0026ndash;1.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male (female ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.885\u0026ndash;2.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.941\u0026ndash;1.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAJCC III(I、II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.109\u0026ndash;2.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.359\u0026ndash;3.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Approach, PD (DP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.731\u0026ndash;1.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased SUA (dec./stable SUA ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.996\u0026ndash;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.994\u0026ndash;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CA199(increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.999\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.552\u0026ndash;1.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiliary fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.246\u0026ndash;4.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.075\u0026ndash;4.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.836\u0026ndash;3.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-abdominal infection (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.647\u0026ndash;1.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurovascular involvement (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.229\u0026ndash;2.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.574\u0026ndash;3.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Total Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.996-1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.997\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.359\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Direct Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.995-1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.996\u0026ndash;1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative indirect bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.999\u0026ndash;1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eHR, Hazard Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdditionally, we performed Cox regression analysis on recurrence-free survival within the radical resection group, and the results showed that AJCC stage III, elevated SUA levels, neurovascular invasion, higher preoperative total bilirubin, and increased preoperative direct bilirubin were linked to recurrence timing. Multivariate analysis revealed that AJCC stage III (HR 1.872, 95% CI 1.171\u0026ndash;2.993, p\u0026thinsp;=\u0026thinsp;0.009), SUA levels (HR 2.961, 95% CI 1.840\u0026ndash;4.764, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and neurovascular invasion (HR 2.253, 95% CI 1.526\u0026ndash;3.327, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) are independent prognostic factors influencing recurrence timing (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox Proportional Hazards Analysis of Prognostic Factors for Recurrence-Free Survival Before Propensity Score Matching (Radical Resection Group)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.977\u0026ndash;1.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male (female ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.870\u0026ndash;1.832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.944\u0026ndash;1.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAJCC III(I、II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.878\u0026ndash;2.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Approach, PD (DP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.780\u0026ndash;1.895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased SUA (dec./stable SUA ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.996\u0026ndash;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.840\u0026ndash;4.764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CA199(increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.999-1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.573\u0026ndash;1.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiliary fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.339\u0026ndash;3.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.770\u0026ndash;3.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-abdominal infection (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.644\u0026ndash;1.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurovascular involvement (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.210\u0026ndash;2.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.526\u0026ndash;3.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Total Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.996\u0026ndash;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.998\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Direct Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.995\u0026ndash;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.996\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative indirect bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.999\u0026ndash;1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eHR, Hazard Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBoth univariate and multivariate analyses showed no statistically significant differences in gender or age. A previous retrospective study indicated that pancreaticoduodenectomy and pancreaticoduodenectomy with resection of the pancreatic body and tail are standard procedures tailored to different tumor locations, with no statistically significant difference in survival rates between the two approaches \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. The findings of this study align with the conclusion above, suggesting that the type of surgery does not significantly impact the overall survival time of pancreatic cancer patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Analysis of prognostic factors in Palliative Care Group\u003c/h2\u003e \u003cp\u003eIn the palliative treatment group, both univariate and multivariate regression analyses showed that none of the clinical variables, including age, sex, BMI, SUA levels, preoperative CA199 levels, and bilirubin levels, were significantly correlated with overall mortality (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e4\u003c/span\u003e, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Further confirmation that these variables held no significant predictive value for overall survival was provided by Cox regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e5\u003c/span\u003e, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Consequently, in this patient cohort, SUA levels did not constitute an independent factor influencing mortality risk or overall survival, like other conventional clinical indicators.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk Factors for Overall Mortality in Univariate and Multivariate Regression Analysis (Palliative Care Group)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.903\u0026thinsp;~\u0026thinsp;1.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male (female ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.037\u0026thinsp;~\u0026thinsp;26.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.627\u0026thinsp;~\u0026thinsp;1.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased SUA (dec./stable SUA ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.969\u0026thinsp;~\u0026thinsp;1.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CA199(increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.995\u0026thinsp;~\u0026thinsp;1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Total Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.965\u0026thinsp;~\u0026thinsp;1.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Direct Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.975\u0026thinsp;~\u0026thinsp;1.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative indirect bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.983\u0026thinsp;~\u0026thinsp;1.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eOR, Odds Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox Proportional Hazards Analysis of Overall Survival Prognostic Factors (Palliative Care Group)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.887\u0026ndash;1.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male (female ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.180\u0026ndash;4.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.902\u0026ndash;1.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased SUA (dec./stable SUA ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.976\u0026ndash;1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CA199(increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.998\u0026ndash;1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Total Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.983\u0026ndash;1.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Direct Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.960\u0026ndash;1.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative indirect bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.985\u0026ndash;1.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eHR, Hazard Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the palliative treatment group, the SUA decreased/stable group had a trend toward better survival; however, the Log-rank test revealed no statistically significant difference in overall survival between groups (p\u0026thinsp;=\u0026thinsp;0.068). This lack of significance may result from the small sample size or limited follow-up time, which could have reduced the ability to detect a meaningful effect. Still, the observed trend warrants further exploration and validation in larger prospective studies with longer follow-up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Propensity Score Matching (PSM) analysis\u003c/h2\u003e \u003cp\u003eA 1:1 propensity score matching (PSM) analysis was performed between the two groups of patients undergoing radical resection to minimize the influence of demographic and perioperative information bias. A total of 64 patients were evaluated, with 32 patients in each group.\u003c/p\u003e \u003cp\u003eAfter propensity score matching, no statistically significant differences were observed in any baseline characteristics between the groups with decreased/stable versus increased serum uric acid in the radical surgery group (Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). These characteristics included age, gender, BMI, history of underlying diseases, tumor histology, location, stage, and surgical approach. Furthermore, secondary outcome measures revealed no significant differences between the groups in terms of length of hospital stay, hospitalization costs, or incidence of postoperative complications, including pancreatic fistula, biliary fistula, bleeding, and intra-abdominal infection (Table\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In summary, under conditions of balanced baseline characteristics, postoperative changes in serum uric acid levels did not significantly impact patients' short-term perioperative outcomes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of the Uric Acid Decreased/Stable Group and the Uric Acid Increased Group After Propensity Score Matching (Radical Resection Group)\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=\"char\" char=\".\" 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 \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 \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDecreased/Stable SUA(N\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncreased SUA\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;32)\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, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.69\u0026thinsp;\u0026plusmn;\u0026thinsp;10.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40(62.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(56.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(68.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24(37.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(43.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(31.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(21.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(18.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(29.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(21.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(37.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking History, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33(51.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(53.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of Alcohol Consumption, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(32.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(28.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(37.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathological Subtyping, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63(98.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(100.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(96.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(3.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead of pancreas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(17.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(9.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic body and tail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(12.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(6.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(18.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45(70.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(68.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(71.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurovascular invasion, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31(48.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(46.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAJCC Staging, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1、2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52(81.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(81.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(81.25)\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\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(18.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(18.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(18.75)\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\u003eType of Surgery, 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 \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreaticoduodenectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56(87.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(87.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(87.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal Pancreatectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(12.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(12.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(12.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSecondary Outcome Measures in the Uric Acid Reduction/Stabilization Group and the Uric Acid Elevation Group After Propensity Score Matching (Radical Resection Group)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDecreased/Stable SUA(N\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eIncreased SUA\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay /D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e25.63\u0026thinsp;\u0026plusmn;\u0026thinsp;7.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization Costs /\u0026times; 10⁴ CNY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic fistula, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(34.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e12(37.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10(31.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiliary fistula, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(3.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(6.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(7.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2(6.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(9.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-abdominal infection, N(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41(64.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e19(59.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22(68.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Analysis of prognostic factors in the Radical Resection Group after propensity score matching\u003c/h2\u003e \u003cp\u003eUnivariate Cox regression analysis of overall mortality in the radical resection group of the PSM cohort showed that SUA levels, pancreatic fistula, and neurovascular invasion were linked to survival time. Multivariate analysis identified SUA level (HR 4.558, 95% CI 2.145\u0026ndash;9.685, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and neurovascular involvement (HR 2.490, 95% CI 1.229\u0026ndash;5.044, p\u0026thinsp;=\u0026thinsp;0.011) as independent prognostic factors affecting patient survival time (Table\u0026nbsp;\u003cspan refid=\"Tab11\" class=\"InternalRef\"\u003e11\u003c/span\u003e). Univariate Cox regression analysis of recurrence-free survival in the radical resection group found that BMI, SUA levels, pancreatic fistula, and neurovascular invasion were associated with recurrence time. Multivariate analysis showed that BMI (HR 1.227, 95% CI 1.094\u0026ndash;1.375, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), SUA level (HR 7.544, 95% CI 3.455\u0026ndash;16.476, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), pancreatic fistula (HR 0.384, 95% CI 0.186\u0026ndash;0.794, p\u0026thinsp;=\u0026thinsp;0.010), and neurovascular invasion (HR 2.171, 95% CI 1.102\u0026ndash;4.277, p\u0026thinsp;=\u0026thinsp;0.025) were independent risk factors impacting recurrence time (Table\u0026nbsp;\u003cspan refid=\"Tab12\" class=\"InternalRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab11\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 11\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox Proportional Hazards Analysis of Overall Survival Prognosis Factors After Propensity Score Matching (Radical Resection Group)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63\u0026ndash;1.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male (female ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.662\u0026ndash;2.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.951\u0026ndash;1.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAJCC III(I、II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.745\u0026ndash;3.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Approach, PD (DP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.651\u0026ndash;4.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased SUA (dec./stable SUA ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.935\u0026ndash;15.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.145\u0026ndash;9.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CA199(increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.999\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.103\u0026ndash;0.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.213\u0026ndash;1.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiliary fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.893\u0026ndash;19.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-abdominal infection (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.625\u0026ndash;3.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurovascular involvement (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.080\u0026ndash;5.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.229\u0026ndash;5.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Total Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.993\u0026ndash;1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Direct Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.993\u0026ndash;1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative indirect bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.996\u0026ndash;1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eHR, Hazard Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab12\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 12\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox Proportional Hazards Analysis of Prognostic Factors for Recurrence-Free Survival After Propensity Score Matching (Radical Resection Group)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.941\u0026ndash;1.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male (female ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.550\u0026ndash;2.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.015\u0026ndash;1.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.094\u0026ndash;1.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAJCC III(I、II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.662\u0026ndash;3.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Approach, PD (DP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.627\u0026ndash;3.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased SUA (dec./stable SUA ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.798\u0026ndash;11.621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.455\u0026ndash;16.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CA199(increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.999\u0026ndash;1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.125\u0026ndash;0.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.186\u0026ndash;0.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiliary fistula (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.059\u0026ndash;5.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.390\u0026ndash;4.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-abdominal infection (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.627\u0026ndash;3.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurovascular involvement (positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.244\u0026ndash;5.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.102\u0026ndash;4.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Total Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.995\u0026ndash;1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Direct Bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.991\u0026ndash;1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative indirect bilirubin (increasing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.987\u0026ndash;1.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eHR, Hazard Ratio\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this study, the 3-year overall survival (OS) after resection of pancreatic cancer was 16.3%, significantly lower than previously reported conditional survival rates of 55% at 1 year and 74% at 3 years post-surgery \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. This difference indicates that multiple factors influence long-term prognosis in pancreatic cancer. Cox regression analysis confirmed elevated serum uric acid (SUA) as an independent predictor of OS, consistent with existing evidence. Notably, a prospective UK Biobank cohort study by Huang et al. \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e (N\u0026thinsp;=\u0026thinsp;444,462) showed that elevated SUA has gender-specific associations, increasing the risk of pancreatic cancer in women and gallbladder cancer in men.\u003c/p\u003e \u003cp\u003eFurthermore, a clinical study involving 466 patients diagnosed with pancreatic ductal adenocarcinoma further confirmed that elevated SUA levels serve as a marker of poor prognosis in pancreatic cancer patients \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. This association was validated in our study via Kaplan-Meier analysis: patients with decreased/stable SUA levels demonstrated significantly superior 3-year OS and RFS compared to those with elevated SUA levels (OS: 16.3% vs. 12.9%; RFS: 17.4% vs. 9.2%). Collectively, these findings indicate that SUA levels are closely associated with postoperative prognosis in pancreatic cancer, suggesting that active monitoring and control of SUA levels are clinically necessary to improve patient survival outcomes.\u003c/p\u003e \u003cp\u003eBasic studies have shown that SUA promotes tumor growth through the xanthine oxidase (XOR)-COX-2 pathway \u003csup\u003e[\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e, providing a mechanistic explanation for its prognostic significance in pancreatic cancer. Ohtsubo et al. \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e demonstrated that SUA controls COX-2 via XOR, and Xie et al. \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e confirmed that COX-2 elevation encourages growth in pancreatic cancer cells\u0026mdash;consistent with our clinical findings of worse outcomes associated with high SUA. Notably, low XOR may increase COX-2 levels to boost proliferation, while tumor cell death raises SUA, creating a vicious cycle \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. Shin et al. \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e proposed SUA as a predictor of survival in advanced cancer, and Fini et al. \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e identified it as an independent risk factor for cancer development and death by aiding tumor transformation and growth. Additionally, high SUA triggers inflammatory stress and promotes cellular transformation inside cells, while extracellular SUA stimulates tumor cell growth, movement, and survival \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Therefore, monitoring SUA could help identify high-risk patients and enable early treatment. More research is needed to understand the role of SUA in the pancreatic cancer microenvironment and its potential for clinical use.\u003c/p\u003e \u003cp\u003e The American Joint Committee on Cancer (AJCC) pathological staging system is the global standard for pancreatic cancer management. A study of 5,097 patients confirmed the 8th edition AJCC stage as an independent prognostic factor, with mortality risk increasing as the stage advances \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. Consistently, we observed higher stages associated with worse overall survival (OS) and recurrence-free survival (RFS). However, limitations remain; an analysis of 45,856 patients showed varied survival rates within the same stage, indicating the need for better prognostic accuracy \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. Incorporating new biomarkers may improve staging precision \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. Notably, our subgroup analysis demonstrated that patients with stable or decreased SUA levels had better survival across all AJCC stages, suggesting that tracking changes in SUA could improve prognostic assessment and aid in more accurate clinical decision-making.\u003c/p\u003e \u003cp\u003ePerineural invasion (PNI) is a key pathological feature of pancreatic ductal adenocarcinoma (PDAC), occurring more often than in other cancers \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. It is defined as cancer cell invasion along or within nerve sheaths \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e and is linked to pain, recurrence, and lower survival rates. Molecularly, PNI involves cancer-produced neurotrophic factors (e.g., NGF, GDNF), chemokines (e.g., CCL2), and adhesion molecules (e.g., NCAM, L1CAM), which promote neural invasion and modify the tumor environment to support metastasis \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. Our survival analysis confirms that neurovascular invasion predicts significantly worse overall and recurrence-free survival. Detecting PNI early may help guide clinical decisions, and targeting its molecular pathways offers a promising approach to improve prognosis.\u003c/p\u003e \u003cp\u003ePostoperative pancreatic fistula (POPF), as defined by the ISGPS, involves drain amylase levels exceeding three times the upper normal serum level on or after postoperative day 3 \u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e. POPF is graded as: Grade A (biochemical, asymptomatic); Grade B (requiring management such as antibiotics or nutritional support); or Grade C (necessitating primary intervention like drainage or reoperation) \u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e. This study included only Grade A POPF, which had no significant clinical impact. Although previous research in 200 pancreatoduodenectomy patients indicated that Grade B/C POPF prolongs hospitalization without increasing mortality \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e, our propensity score-matched analysis revealed an association between POPF and recurrence-free survival. Given the limited sample size, further validation in larger prospective studies is needed to clarify the effect of POPF on long-term outcomes in pancreatic cancer.\u003c/p\u003e \u003cp\u003eBoth high and low BMI are linked to adverse outcomes after pancreatoduodenectomy. A study of 1,384 patients showed that obesity extends hospital stays and increases pancreatic cancer incidence and mortality \u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e. Temraz S et al. \u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e (N\u0026thinsp;=\u0026thinsp;236) reported that preoperative weight loss and BMI over 30 raise postoperative complication risks, emphasizing the importance of nutritional support and weight management. Conversely, a study of 329 patients found that BMI\u0026thinsp;\u0026lt;\u0026thinsp;25 is associated with worse overall survival \u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e. Although our Cox regression did not identify BMI as a significant factor for overall survival, it revealed a statistically significant link with recurrence-free survival. These consistent findings underscore the clinical importance of maintaining an appropriate BMI, although the molecular mechanisms need further investigation.\u003c/p\u003e \u003cp\u003eIn the PSM cohort analysis, elevated SUA and neurovascular invasion remained independent risk factors for overall survival (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) after adjusting for confounders. These findings support incorporating SUA management into comprehensive pancreatic cancer care. Preoperative SUA screening should be performed, with urate-lowering therapy (e.g., allopurinol or febuxostat) considered for elevated levels. Postoperative monitoring and control of SUA (increase\u0026thinsp;\u0026lt;\u0026thinsp;10%) may help reduce recurrence risk. Perioperative strategies should also include nutritional support for underweight or cachectic patients \u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e and weight management for those with obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30) \u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e. As a modifiable factor, SUA is a potential target for standardized follow-up and intervention. Prospective studies are needed to assess its impact on survival.\u003c/p\u003e \u003cp\u003ePainless jaundice is a common presentation in pancreatic head adenocarcinoma. Preoperative jaundice has been identified as an independent negative prognostic factor \u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e. Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred method for preoperative biliary drainage, with endoscopic ultrasound-guided (EUS-BD) or percutaneous transhepatic drainage (PTBD) as alternatives if ERCP fails \u003csup\u003e[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e. Preoperative ERCP stent placement is associated with significantly improved survival (HR\u0026thinsp;=\u0026thinsp;0.59, 95% CI 0.41\u0026ndash;0.85, P\u0026thinsp;=\u0026thinsp;0.005) \u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e. Alternative approaches, such as hepaticogastrostomy (HGS) or choledochoduodenostomy (CDS), may be considered when cannulation is unsuccessful \u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e. Although no significant difference was observed in the palliative group in this study\u0026mdash;possibly due to sample size limitations\u0026mdash;multiple studies support preoperative biliary drainage to improve survival in jaundiced patients.\u003c/p\u003e \u003cp\u003eThis study offers the first systematic analysis connecting serum uric acid (SUA) levels to postoperative outcomes in pancreatic cancer. Key methodological strengths include thorough adjustment for risk factors and the use of propensity score matching (PSM) to minimize confounding. Elevated SUA remained significantly linked to worse survival even after multivariate adjustment. However, some limitations must be noted. First, although PSM accounted for known confounders, the retrospective design still risks selection bias and unmeasured variables. Second, the clinical data do not provide mechanistic insight into how SUA impacts pancreatic cancer progression. Future research should focus on: 1) prospective cohorts with standardized SUA measurement protocols to confirm these results; and 2) interventional trials testing whether perioperative urate-lowering therapies (such as allopurinol) enhance surgical outcomes. If these findings are validated, SUA monitoring could be integrated into existing prognostic models like AJCC staging to improve risk stratification. Additionally, metabolic optimization (including SUA control) may serve as a valuable addition to the multidisciplinary management of pancreatic cancer.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis cohort study identifies elevated serum uric acid (SUA) as an independent predictor of adverse postoperative outcomes in resected pancreatic cancer patients, supporting its potential use as a prognostic biomarker. Monitoring and managing SUA around the time of surgery may help with risk assessment and guide personalized treatment plans. These findings require validation through larger, prospective multicenter studies, and more mechanistic research is necessary to understand the biological pathways linking SUA to pancreatic cancer progression.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAJCC, American Joint Committee on Cancer\u003c/p\u003e\n\u003cp\u003eBRPC, borderline resectable pancreatic cancer\u003c/p\u003e\n\u003cp\u003eBMI, body mass index\u003c/p\u003e\n\u003cp\u003eCDS, choledochoduodenostomy\u003c/p\u003e\n\u003cp\u003eERCP,\u0026nbsp;endoscopic retrograde cholangiopancreatography\u003c/p\u003e\n\u003cp\u003eEUS-BD, endoscopic ultrasound-guided\u003c/p\u003e\n\u003cp\u003eHGS, hepaticogastrostomy\u003c/p\u003e\n\u003cp\u003eLAPC, locally advanced pancreatic cancer\u003c/p\u003e\n\u003cp\u003eOS, overall survival\u003c/p\u003e\n\u003cp\u003ePRPC, primary resectable pancreatic cancer\u003c/p\u003e\n\u003cp\u003ePSM, propensity score matching\u003c/p\u003e\n\u003cp\u003ePNI, perineural invasion\u003c/p\u003e\n\u003cp\u003ePDAC, pancreatic ductal adenocarcinoma\u003c/p\u003e\n\u003cp\u003ePOPF, postoperative pancreatic fistula\u003c/p\u003e\n\u003cp\u003ePTBD, percutaneous transhepatic drainage\u003c/p\u003e\n\u003cp\u003eRFS, recurrence-free survival\u003c/p\u003e\n\u003cp\u003eXOR, xanthine oxidase\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to Shen Cheng, Chenyang Wei, Pengfei Li, Ping Yue, Yanyan Lin, Long Gao, and Wenbo Meng.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhengping, An: Conceptualization; Methodology; Data Curation; Writing–Original Draft; Writing–Review and Editing. Sheng, Chen: Investigation; Data Curation. Chenyang, Wei: Investigation; Data Curation. Pengfei, Li: Investigation; Data Curation. Ping, Yue: Writing–Review and Editing; Project Administration. Yanyan, Lin: Writing–Review and Editing; Project Administration. Long, Gao: Conceptualization; Supervision; Writing–Review and Editing; Funding Acquisition. Wenbo, Meng: Conceptualization; Supervision; Writing–Review and Editing; Funding Acquisition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the National Natural Science Foundation of China (82560492) and the National Key Research and Development Program of China (2022YFC2407405). The funders had no role in the study design, data collection, analysis, interpretation, manuscript writing, or the decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data for this study were obtained from the First Hospital of Lanzhou University. The study was registered with ClinicalTrials.gov on July 21, 2025. The registration number is NCT07091526. Additional information is available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients provided informed consent. This study complies with the Declaration of Helsinki and was approved by the Ethics Committee of the First Hospital of Lanzhou University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCharacteristics. and outcomes of pancreatic cancer by histological subtypes \u0026ndash; PubMed [EB/OL]. [2025-04-15]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/31210663/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/31210663/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSIEGEL R L, GIAQUINTO A N JEMALA. Cancer statistics, 2024[J]. Cancer J Clin. 2024;74(1):12\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSIEGEL R L SUNGH. Global patterns in excess body weight and the associated cancer burden[J]. Cancer J Clin. 2019;69(2):88\u0026ndash;112.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHUGHES T, HARPER A, GUPTA S, et al. The current and future global burden of cancer among adolescents and young adults: A population-based study[J]. Lancet Oncol. 2024;25(12):1614\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSIEGEL R L SUNGH, ROSENBERG PS, et al. Emerging cancer trends among young adults in the USA: Analysis of a population-based cancer registry[J]. Lancet Public Health. 2019;4(3):e137\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHUANG L, JANSEN L, BALAVARCA Y, et al. Resection of pancreatic cancer in europe and USA: An international large-scale study highlighting large variations[J]. Gut. 2019;68(1):130\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMACKAY TM, VAN ERNING F N, VAN DER GEEST L G, M et al. Association between primary origin (head, body and tail) of metastasised pancreatic ductal adenocarcinoma and oncologic outcome: A population-based analysis[J]. European Journal of Cancer (Oxford, England: 1990), 2019, 106: 99\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSTOOP T F, THEIJSE R T, SEELEN L W F, et al. Preoperative chemotherapy, radiotherapy, and surgical decision-making in patients with borderline resectable and locally advanced pancreatic cancer[J]. Nat Rev Gastroenterol Hepatol. 2024;21(2):101\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCONROY T, PFEIFFER P. Pancreatic cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up[J]. Annals Oncology: Official J Eur Soc Med Oncol. 2023;34(11):987\u0026ndash;1002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLIAO W C, CHIEN K L, LIN Y L, et al. Adjuvant treatments for resected pancreatic adenocarcinoma: A systematic review and network meta-analysis[J]. Lancet Oncol. 2013;14(11):1095\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVAN GOOR I W J M, SCHOUTEN T J, VERBURG D N, et al. Predicting long-term disease-free survival after resection of pancreatic ductal adenocarcinoma: A nationwide cohort study[J]. Ann Surg. 2024;279(1):132\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDORLAND DAAMENLA, BRADA L J H G, et al. Preoperative predictors for early and very early disease recurrence in patients undergoing resection of pancreatic ductal adenocarcinoma[J]. HPB: official J Int Hepato Pancreato Biliary Association. 2022;24(4):535\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBENGTSSON A, ANDERSSON R. The actual 5-year survivors of pancreatic ductal adenocarcinoma based on real-world data[J]. Sci Rep. 2020;10(1):16425.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTEMPERO M A, MALAFA M P, AL-HAWARY M, et al. Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw. 2017;15(8):1028\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026Aacute;NCHEZ-VEL\u0026Aacute;ZQUEZ P, MULLER X. Benchmarks in pancreatic surgery: A novel tool for unbiased outcome comparisons[J]. Ann Surg. 2019;270(2):211\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDURIN T, MARCHESE U. Defining benchmark outcomes for distal pancreatectomy: Results of a French multicentric study[J]. Ann Surg. 2023;278(1):103\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLOOS M, AL-SAEEDI M, HINZ U, et al. Categorization of differing types of total pancreatectomy[J]. JAMA Surg. 2022;157(2):120\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEarly detection of. pancreatic cancer - PubMed [EB/OL]. [2025-04-16]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/32135127/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/32135127/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJIANG M, GONG D, FAN Y. Serum uric acid levels and risk of prehypertension: A meta-analysis[J]. Clin Chem Lab Med. 2017;55(3):314\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRegulation of uric acid. metabolism and excretion - PubMed[EB/OL]. [2025-04-17]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/26316329/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/26316329/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGRIEBSCH A, Z\u0026Ouml;LLNER N. Effect of ribomononucleotides given orally on uric acid production in man[J]. Adv Exp Med Biol. 1974;41:443\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026Uuml;HN T, SOOKTHAI D, GRAF M E, et al. Albumin, bilirubin, uric acid and cancer risk: Results from a prospective population-based study[J]. Br J Cancer. 2017;117(10):1572\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLAWAL A O KOLUDEB. ADEYEMI B F. Serum uric acid levels in oral cancer patients seen at tertiary institution in nigeria[J]. Annals Ib Postgrad Med. 2012;10(1):9\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBENLI E, CIRAKOGLU A, AYYILDIZ S N, et al. Comparison of serum uric acid levels between prostate cancer patients and a control group[J]. Cent Eur J Urol. 2018;71(2):242\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSTRASAK AM, RAPP K, HILBE W, et al. The role of serum uric acid as an antioxidant protecting against cancer: Prospective study in more than 28 000 older austrian women[J]. Annals Oncology: Official J Eur Soc Med Oncol. 2007;18(11):1893\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHUANG C F, HUANG J J, MI N N, et al. Associations between serum uric acid and hepatobiliary-pancreatic cancer: A cohort study[J]. World J Gastroenterol. 2020;26(44):7061\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYAN S, ZHANG P, XU W et al. Serum uric acid increases risk of cancer incidence and mortality: A systematic review and meta-analysis[J]. Mediators of Inflammation, 2015, 2015: 764250.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRIC\u0026Oacute;S C, ALVAREZ V, CAVA F. Current databases on biological variation: Pros, cons and progress[J]. Scand J Clin Lab Investig. 1999;59(7):491\u0026ndash;500.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYIM K, BINDAYI A, MCKAY R, et al. Rising serum uric acid level is negatively associated with survival in renal cell carcinoma[J]. Cancers. 2019;11(4):536.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFOR THE DUTCH PANCREATIC CANCER GROUP, LATENSTEIN A E J, VAN ROESSEL S, et al. Conditional survival after resection for pancreatic cancer: A population-based study and prediction model[J]. Ann Surg Oncol. 2020;27(7):2516\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSTOTZ M, SZKANDERA J, SEIDEL J, et al. Evaluation of uric acid as a prognostic blood-based marker in a large cohort of pancreatic cancer patients[J]. PLoS ONE. 2014;9(8):e104730.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHILLE R. Molybdenum-containing hydroxylases[J]. Arch Biochem Biophys. 2005;433(1):107\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOHTSUBO T, ROVIRA I I, STAROST M F, et al. Xanthine oxidoreductase is an endogenous regulator of cyclooxygenase-2[J]. Circul Res. 2004;95(11):1118\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXIE C, XU X, WANG X et al. Cyclooxygenase\u0026ndash;2 induces angiogenesis in pancreatic cancer mediated by prostaglandin E2[J/OL]. Oncology Letters, 2018[2025-08-11]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.spandidos-publications.com/\u003c/span\u003e\u003cspan address=\"http://www.spandidos-publications.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3892/ol.2018.8786\u003c/span\u003e\u003cspan address=\"10.3892/ol.2018.8786\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFINI MA, JOHNSON R J ELIASA, et al. Contribution of uric acid to cancer risk, recurrence, and mortality[J]. Clin Translational Med. 2012;1(1):e16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSHIN HS, LEE H R, LEE D C, et al. Uric acid as a prognostic factor for survival time: A prospective cohort study of terminally ill cancer patients[J]. J Pain Symptom Manag. 2006;31(6):493\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLI C, REN Z. A prognostic nomogram for pancreatic ductal adenocarcinoma patients\u0026rsquo; all-cause survival in a surveillance, epidemiology, and end results analysis[J]. Translational Cancer Res. 2020;9(5):3586\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSHI S, HUA J, LIANG C, et al. Proposed modification of the 8th edition of the AJCC staging system for pancreatic ductal adenocarcinoma[J]. Ann Surg. 2019;269(5):944\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVAN ROESSEL S, KASUMOVA G G, VERHEIJ J, et al. International validation of the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system in patients with resected pancreatic cancer[J]. JAMA Surg. 2018;153(12):e183617.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGASPARINI G, PELLEGATTA M. Nerves and pancreatic cancer: New insights into a dangerous relationship[J]. Cancers. 2019;11(7):893.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLIEBL F, DEMIR I E, MAYER K, et al. The impact of neural invasion severity in gastrointestinal malignancies: A clinicopathological study[J]. Ann Surg. 2014;260(5):900\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDEMIR I E, CEYHAN G O, LIEBL F, et al. Neural invasion in pancreatic cancer: The past, present, and future[J]. Cancers. 2010;2(3):1513\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBASSI C, DERVENIS C, BUTTURINI G, et al. Postoperative pancreatic fistula: An international study group (ISGPF) definition[J]. Surgery. 2005;138(1):8\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eENDERES J, PILLNY C, MATTHAEI H, et al. Clinically relevant pancreatic fistula after pancreaticoduodenectomy: How we do it[J]. Biology. 2023;12(2):178.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePERRONE V G, IACOPI S, AMORESE G, et al. Impact of nutritional status on outcome of pancreatic resections for pancreatic cancer and periampullary tumors[J]. Hepatobiliary Surg Nutr. 2020;9(5):669\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTEMRAZ S, CHARAFEDDINE M. Pre-operative markers of post-operative complications in pancreatic cancer patients: A single-center study[J]. J Epidemiol Global Health. 2025;15(1):28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCUI L, YU H, SUN Q, et al. Effects of body mass index and serum albumin on overall survival in patients with cancer undergoing pancreaticoduodenectomy: A single-center retrospective cohort study[J]. World J Surg Oncol. 2022;20(1):221.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSTRASBERG SM, GAO F, SANFORD D, et al. Jaundice: An important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas[J]. HPB. 2014;16(2):150\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNEHME F, LEE JH. Preoperative biliary drainage for pancreatic cancer[J]. Dig Endoscopy. 2022;34(3):428\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMAZUR R, TRNA J. Principles of palliative and supportive care in pancreatic cancer: A review[J]. Biomedicines. 2023;11(10):2690.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Serum uric acid, pancreatic cancer, overall survival, recurrence-free survival","lastPublishedDoi":"10.21203/rs.3.rs-9008446/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9008446/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAlthough elevated serum uric acid (SUA) is a known risk factor for cancer-related death, its prognostic role after pancreatic cancer surgery remains unclear. This retrospective study of 198 patients who underwent pancreatic cancer surgery, 168 of whom received curative treatment. Of these patients, 119 (70.8%) exhibited increased SUA levels postoperatively, while 49 (29.2%) experienced decreased or stable levels. Patients with decreased or stable SUA exhibited better three-year overall survival (16.3% vs. 12.9%) and recurrence-free survival (17.4% vs. 9.2%). Multivariate analysis identified AJCC stage III as a significant risk factor for all-cause mortality (OR 7.065, p\u0026thinsp;=\u0026thinsp;0.002). Cox regression analysis identified AJCC stage III (HR 2.157, p\u0026thinsp;=\u0026thinsp;0.002), elevated SUA (HR 0.996, p\u0026thinsp;=\u0026thinsp;0.005), and neurovascular invasion (HR 2.421, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as independent predictors of poorer overall survival. Similar trends were observed for recurrence-free survival. No significant differences were found in the palliative group. Early detection of these factors may facilitate timely intervention and improve outcomes.\u003c/p\u003e","manuscriptTitle":"The Role of Serum Uric Acids in Protecting Postoperative Survival in Pancreatic Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 15:55:39","doi":"10.21203/rs.3.rs-9008446/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-25T02:38:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113044005263409686545993059650002299166","date":"2026-03-23T22:16:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"239887519830437915932229788193903076514","date":"2026-03-16T06:06:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-16T04:26:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-06T18:31:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-05T11:34:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-05T11:29:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-03-02T09:29:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"20a7a032-8e45-49a3-8ca7-f1472b26e8ce","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T15:55:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 15:55:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9008446","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9008446","identity":"rs-9008446","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}