A Chemotherapy Progression Decision Score for Treatment Selection After Initial Assessment in Pancreatic Ductal Adenocarcinoma

Yixin Zhang; Zhongquan Sun; Hongfan Ding; Changlin Zou; Linping Dong; Qi Xu; Jiali Ji; Xin Han; Hanqi Yu; Daqian Xu; Gaopeng Li; Yuhao Wang; Haoliang He; Yufeng Zhong; Xiaochang Wu; Jieer Ying; Weilin Wang; Yuan Ding

doi:10.1002/mco2.70903

MedComm ›› 2026, Vol. 7 ›› Issue (8) :e70903 DOI: 10.1002/mco2.70903

ORIGINAL ARTICLE

A Chemotherapy Progression Decision Score for Treatment Selection After Initial Assessment in Pancreatic Ductal Adenocarcinoma

Yixin Zhang ¹^,²^,³^,⁴^,⁵^,⁶
, Zhongquan Sun ¹^,²^,³^,⁴^,⁵^,⁶
, Hongfan Ding ¹^,²^,³^,⁴^,⁵^,⁶
, Changlin Zou ⁷
, Linping Dong ⁸
, Qi Xu ⁹
, Jiali Ji ¹^,²^,³^,⁴^,⁵^,⁶
, Xin Han ¹^,²^,³^,⁴^,⁵^,⁶
, Hanqi Yu ¹^,²^,³^,⁴^,⁵^,⁶
, Daqian Xu ¹⁰
, Gaopeng Li ¹¹
, Yuhao Wang ¹⁰
, Haoliang He ¹^,²^,³^,⁴^,⁵^,⁶
, Yufeng Zhong ¹^,²^,³^,⁴^,⁵^,⁶
, Xiaochang Wu ¹²
, Jieer Ying ⁹
, Weilin Wang ¹^,²^,³^,⁴^,⁵^,⁶
, Yuan Ding ¹^,²^,³^,⁴^,⁵^,⁶

Author information +

¹. Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

². Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang, China

³. Research Center of Diagnosis and Treatment Technology For Hepatocellular Carcinoma of Zhejiang Province, Hangzhou, Zhejiang, China

⁴. Center For Medical Research and Innovation in Digestive System Tumors, Ministry of Education, Hangzhou, Zhejiang, China

⁵. Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China

⁶. ZJU-Pujian Research & Development Center of Medical Artificial Intelligence for Hepatobiliary and Pancreatic Disease, Hangzhou, Zhejiang, China

⁷. Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

⁸. Department of Hepatobiliary and Pancreatic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China

⁹. Department of Hepato-Pancreato-Biliary & Gastric Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China

¹⁰. Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Institute of Translational Medicine, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China

¹¹. Department of Colorectal Surgery and Oncology of the Second Affiliated Hospital and Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China

¹². Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, China

wuxiaochang88@sina.com

jieerying@aliyun.com

wam@zju.edu.cn

dingyuan@zju.edu.cn

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Abstract

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with chemotherapy response evaluation currently relying on the Response Evaluation Criteria in Solid Tumors (RECIST). However, RECIST inadequately captures the unique biology of PDAC, particularly stromal fibrosis–induced radiographic pseudoprogression. We developed and externally validated a multivariable prognostic prediction model, the chemotherapy Progression Decision (cPD) score, integrating biological markers and imaging metrics to guide therapeutic decision-making after the first RECIST assessment. This multicenter retrospective study enrolled 616 PDAC patients across three cohorts: the Training Cohort (n = 155), Validation Cohort 1 (n = 263), and Validation Cohort 2 (n = 198). Multivariable Cox regression identified four independent prognostic predictors: neutrophil-to-lymphocyte ratio, baseline carbohydrate antigen 19-9, tumor maximum cross-sectional rate change ratio, and emergence of new lesions. These were integrated into an integer-based score (8–13 points) stratifying patients into good prognosis (GP), poor prognosis (PP), and critical prognosis (CP) groups. The cPD model demonstrated robust discrimination and calibration, with significant survival differences across groups in all cohorts. Notably, the cPD score identified a subset of patients (GP and PP groups) for whom continuing the original chemotherapy yielded significantly better survival than switching regimens, even when RECIST classified the disease as progressive.

Keywords

chemotherapy response / pancreatic ductal adenocarcinoma / prognostic prediction model / radiographic pseudoprogression / treatment decision-making

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Yixin Zhang, Zhongquan Sun, Hongfan Ding, Changlin Zou, Linping Dong, Qi Xu, Jiali Ji, Xin Han, Hanqi Yu, Daqian Xu, Gaopeng Li, Yuhao Wang, Haoliang He, Yufeng Zhong, Xiaochang Wu, Jieer Ying, Weilin Wang, Yuan Ding. A Chemotherapy Progression Decision Score for Treatment Selection After Initial Assessment in Pancreatic Ductal Adenocarcinoma. MedComm, 2026, 7 (8) : e70903 DOI:10.1002/mco2.70903

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