A combined carbohydrate antigen 125 and lymphocyte-to-monocyte ratio score stratifies time-window-specific recurrence after pancreatic cancer surgery

BackgroundEarly recurrence after pancreatic resection is a major cause of treatment failure in pancreatic cancer. We evaluated whether a score combining carbohydrate antigen 125 (CA125) with the lymphocyte-to-monocyte ratio (LMR) could stratify recurrence risk across clinically relevant time windows.MethodsThis retrospective cohort included 1,618 patients who underwent pancreatic cancer surgery. Recurrence within 6, 12, and 24 months was defined as ER6, ER12, and ER24, respectively, with ER12 prespecified as the primary endpoint. ER12-derived cutoffs were 44.760 U/mL for CA125 and 5.764 for LMR; one point was assigned for elevated CA125 and one for low LMR, yielding a 0–2 score. Discrimination was assessed using receiver operating characteristic curves and pairwise DeLong tests, and disease-free survival was evaluated using Kaplan–Meier analysis.ResultsER12 occurred in 779 patients (48.1%). For ER12, the CA125-LMR score yielded an area under the curve (AUC) of 0.742 [95% confidence interval (CI), 0.720–0.764], with 91.4% sensitivity and 44.3% specificity. Its AUC exceeded those of CA125 alone (0.698; p < 0.001) and the CA19-9-LMR score (0.692; p < 0.001), but did not differ significantly from that of LMR alone (0.735; p = 0.463). The score showed AUCs of 0.694 for ER6 and 0.809 for ER24; at 24 months, LMR alone performed better (AUC, 0.835; p = 0.003). Disease-free survival decreased stepwise across scores 0, 1, and 2 (log-rank p < 0.001).ConclusionThe CA125-LMR score is a simple, interpretable tool for recurrence-risk stratification after pancreatic cancer surgery, with its clearest utility in early and intermediate time windows. External validation is required before clinical implementation.