Preoperative Serum Total Cholesterol Predicts Adjuvant Chemotherapy Completion After Pancreaticoduodenectomy for Pancreatic Cancer

Background/Aim: Completion of adjuvant chemotherapy (AC) is a key determinant of long-term survival after curative-intent resection for pancreatic cancer. However, predictors of AC completion remain unclear. This study aimed to clarify the prognostic significance of AC non-completion and identify host-related factors after pancreaticoduodenectomy (PD). Patients and Methods: We retrospectively analyzed 170 patients who were scheduled to receive AC after PD for pancreatic cancer. Associations between AC completion status and survival outcomes were evaluated. Independent predictors of AC non-completion were identified using logistic regression, and model performance was assessed through receiver operating characteristic analysis, calibration plots, and decision curve analysis (DCA). Results: Of the 170 patients, 116 (68.2%) completed standard AC (complete group), whereas 54 (31.8%) discontinued treatment (incomplete group). The 5-year survival rate was significantly lower in the incomplete group than in the complete group (16.7% vs. 45.3%, p<0.001). Low serum total cholesterol (T-chol) independently predicted poor AC tolerance. The T-chol model demonstrated moderate discrimination (area under the curve: 0.697) and good calibration. DCA indicated a favorable net clinical benefit for T-chol within a threshold probability range of 0.2-0.4. Conclusion: Serum T-chol is a strong predictor of AC completion and may help identify patients with pancreatic cancer who could benefit from targeted nutritional or supportive interventions during the perioperative period.