Evaluation of preoperative pan-immune inflammation value (PIV) combined with clinicopathological parameters in predicting postoperative recurrence of endometrial cancer (EC) and development of a prognostic model for optimized recurrence risk assessment. This retrospective study analyzed a training cohort of 1,275 patients and a validation cohort of 656 patients. Prognostic factors associated with recurrence-free survival (RFS) were identified through univariate and multivariate Cox regression analyses, and a nomogram model was subsequently constructed. The discriminative ability and accuracy of the model were evaluated by using the C-index, area under the curve (AUC), and calibration curve. Patients were stratified into low-risk and high-risk groups based on nomogram, and the clinical utility of the model was validated through Kaplan-Meier survival analysis, providing a robust foundation for clinical decision-making. Cox regression analysis revealed that age (P = 0.012), International Federation of Gynecology and Obstetrics (FIGO) stage (P < 0.001), Ca125 (P = 0.012), lymphovascular space invasion (LVSI) (P = 0.007), myometrial invasion (P < 0.001), histological type (P < 0.001), p53 expression (P = 0.001), adjuvant therapy (P < 0.001), and PIV (P < 0.001) were independent prognostic factors for RFS in EC. We developed a predictive model integrating clinicopathological parameters and PIV, which demonstrated superior performance in predicting 1-, 3-, and 5-year RFS compared with single-indicator models and other conventional models. This nomogram demonstrates high predictive accuracy for RFS in EC patients, offering a robust tool to guide personalized therapeutic strategies in clinical practice.

Increased application of neoadjuvant therapy (NAT) and adjuvant therapy (AT) could limit treatment options for pancreatic ductal adenocarcinoma (PDAC) recurrence. This study aimed to identify patterns of recurrence-focused treatment and survival following different primary treatment strategies. All patients who underwent PDAC resection in the Netherlands (2014-2019) were included. Patients were divided into five groups according to their primary treatment strategy: (1) resection only, (2) gemcitabine-based NAT + resection, (3) FOLFIRINOX-based NAT + resection, (4) resection + gemcitabine-based AT, and (5) resection + FOLFIRINOX-based AT. Differences in recurrence-focused treatment and post-recurrence survival (PRS) were assessed using multivariable logistic and Cox-proportional hazards analyses and were presented as odds ratios (ORs) and hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs), respectively. In total, 1739 patients (median follow-up of 51 [interquartile range 34-64] months) were included, of whom 1272 (73%) had disease recurrence.In these patients, recurrence-focused treatmentwas administered in 64/124 (52%) after FOLFIRINOX-based NAT compared with 74/410 (18%) with resection only (OR 4.13 [95% CI 3.34-5.12]; P<0.001), 29/70 (41%) with gemcitabine-based NAT (OR 1.61 [95% CI 1.21-2.15]; P<0.001), 239/604 (39%) with gemcitabine-based AT (OR 1.73 [95% CI 1.43-2.09]; P<0.001), and 24/64 (38%) with FOLFIRINOX-based AT (OR 1.44 [95% CI 1.06-1.95]; P=0.02). Recurrence-focused treatment was associated with a median PRS of 11 (95% CI 10-13) months compared with 3 (95% CI 2-3) months in patients with best supportive care (HR 0.31 [95% CI 0.26-0.37]; P<0.001). Recurrence-focused treatment differs between patients with PDAC who received different primary treatment strategies and is associated with improved PRS.