Background: Chemotherapy is suggested to use in all stages of pancreatic cancer. Is it reasonable to recommend chemotherapy for all PDAC patients? It is necessary to distinguish low-risk PDAC patients underwent pancreatectomy, who may not lose survival time due to missed chemotherapy and not need to endure pain, nausea, tiredness, drowsiness, and breath shortness caused by chemotherapy. Methods: Nomograms were constructed with basis from the multivariate Cox regression analysis. X-tile software was utilized to perform risk stratification. Survival curves were used to display the effect of chemotherapy in different risk-stratification. Results: All of the significant variables were used to create the nomograms for overall survival (OS). The total risk score of each patient was calculated by summing the scores related to each variable. X-tile software was utilized to classify patients into high-risk (score >283), median-risk (197<score ≤283), and low-risk (score ≤197) according to the total risk score. The low-risk PDAC patients after pancreatectomy cannot gain survival benefit from chemotherapy after surgery (p=0.443). Moreover, chemotherapy improved survival for patients with resected PDAC in the median-risk (p<0.001) and high-risk (p<0.001) groups. Conclusions: our research constructed a new risk-scoring system based on survival nomogram to screen low-risk PDAC patients after pancreatectomy and confirmed that those can avoid enduring side effects caused by chemotherapy without affecting the survival time.
