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Background <p>Pancreatic cancer (PC) remains one of the most lethal malignancies, with high recurrence rates even after curative-intent surgery. Current surveillance tools, including imaging and serum carbohydrate antigen 19–9, have limitations in specificity and sensitivity. N-NOSE is a urine-based assay using the chemotactic behavior of <i>Caenorhabditis elegans</i> to detect cancer-associated volatile organic compounds. This study prospectively evaluated the prognostic value of N-NOSE in patients undergoing curative surgery for resectable PC.</p> Methods <p>Twenty-four patients with resectable PC, all treated with preoperative gemcitabine plus S-1 chemotherapy followed by curative-intent pancreatectomy, were enrolled. The chemotaxis index was measured at three time points: before treatment, after preoperative chemotherapy, and postoperatively. Recurrence within two years was assessed. Univariate and multivariate logistic regression analyses were performed to identify predictors of recurrence, and recurrence-free survival was analyzed using Kaplan–Meier methods.</p> Results <p>During the two-year follow-up, 13 patients (54.2%) experienced recurrence. Univariate analysis identified pre-treatment platelet-to-lymphocyte ratio &gt; 1.53 (<i>p</i> = 0.04), pathological lymph node metastasis (<i>p</i> = 0.04), and pre-treatment N-NOSE positivity (<i>p</i> = 0.007) as significant predictors. Multivariate analysis confirmed pre-treatment N-NOSE positivity as the only independent predictor (odds ratio: 3.10 × 10⁷; 95% CI: 11.38–; <i>p</i> = 0.03). In patients who recurred, the chemotaxis index increased significantly after surgery (<i>p</i> = 0.02), while remaining stable in non-recurrent cases.</p> Conclusions <p>Pre-treatment N-NOSE positivity and postoperative increases in chemotaxis index were associated with recurrence after curative-intent surgery for resectable PC. This simple, non-invasive urine assay shows promise as a novel prognostic biomarker to enable earlier detection of recurrence, refine postoperative surveillance, and support personalized patient management.</p>

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Urine-based nematode chemotaxis assay (N-NOSE) as a predictor of recurrence after curative surgery for resectable pancreatic cancer: preliminary data and single center experience

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Masahiro Fukada,
  • Noriki Mitsui,
  • Takeshi Horaguchi,
  • Itaru Yasufuku,
  • Yuta Sato,
  • Jesse Yu Tajima,
  • Yoshihiro Tanaka,
  • Hideyuki Hatakeyama,
  • Aya Hasan Alshammari,
  • Masayo Morishita,
  • Takaaki Hirotsu,
  • Eric di Luccio,
  • Manabu Futamura,
  • Nobuhisa Matsuhashi

摘要

Background

Pancreatic cancer (PC) remains one of the most lethal malignancies, with high recurrence rates even after curative-intent surgery. Current surveillance tools, including imaging and serum carbohydrate antigen 19–9, have limitations in specificity and sensitivity. N-NOSE is a urine-based assay using the chemotactic behavior of Caenorhabditis elegans to detect cancer-associated volatile organic compounds. This study prospectively evaluated the prognostic value of N-NOSE in patients undergoing curative surgery for resectable PC.

Methods

Twenty-four patients with resectable PC, all treated with preoperative gemcitabine plus S-1 chemotherapy followed by curative-intent pancreatectomy, were enrolled. The chemotaxis index was measured at three time points: before treatment, after preoperative chemotherapy, and postoperatively. Recurrence within two years was assessed. Univariate and multivariate logistic regression analyses were performed to identify predictors of recurrence, and recurrence-free survival was analyzed using Kaplan–Meier methods.

Results

During the two-year follow-up, 13 patients (54.2%) experienced recurrence. Univariate analysis identified pre-treatment platelet-to-lymphocyte ratio > 1.53 (p = 0.04), pathological lymph node metastasis (p = 0.04), and pre-treatment N-NOSE positivity (p = 0.007) as significant predictors. Multivariate analysis confirmed pre-treatment N-NOSE positivity as the only independent predictor (odds ratio: 3.10 × 10⁷; 95% CI: 11.38–; p = 0.03). In patients who recurred, the chemotaxis index increased significantly after surgery (p = 0.02), while remaining stable in non-recurrent cases.

Conclusions

Pre-treatment N-NOSE positivity and postoperative increases in chemotaxis index were associated with recurrence after curative-intent surgery for resectable PC. This simple, non-invasive urine assay shows promise as a novel prognostic biomarker to enable earlier detection of recurrence, refine postoperative surveillance, and support personalized patient management.