吸烟在癌症发生中扮演着重要角色，包括胰腺导管腺癌（PDAC）。然而，关于吸烟状况与切除后PDAC预后的关联知之甚少。从两个前瞻性机构数据库中确定了接受PDAC切除手术的所有患者。提取临床病理数据以及吸烟状况等人口学数据。进行生存分析和多变量Cox回归建模。使用受限立方样条线性数据定义截断点。在848名患者中，357名（42.1％）接受了新辅助治疗（NAT），491名（57.9％）直接手术切除，475名（56％）接受了辅助治疗。整个队列、NAT和直接手术切除后的中位总生存期分别为27.8个月、36.1个月和23.0个月。464名患者是非吸烟者（54.7％），250名既往吸烟者（29.5％）和134名现吸烟者（15.8％）。在多变量模型中，新辅助FOLFIRINOX和主动吸烟的相互作用与降低总生存期的风险最高相关（危险比（HR）为2.35，95％置信区间1.13-4.90），并且严重削弱了FOLFIRINOX的效益（HR为0.40，95％ CI 0.25-0.63）。在接受NAT治疗的患者中，经调整的中位总生存期对于从未吸烟者和既往吸烟者而言没有达到，而对于现吸烟者而言为26.2个月。基于该模型，生成了一个演示PDAC切除后5年生存概率的评分表。本研究确认了新辅助FOLFIRINOX与良好生存率的相关性，并表明主动吸烟减少了其效益。该评分表可以辅助日常临床实践，并强调对于PDAC患者，特别是在接受新辅助FOLFIRINOX治疗之前，戒烟的重要性。版权所有©2023作者。由Elsevier Ltd.发表。保留所有权利。

Smoking plays an important role in carcinogenesis, including pancreatic ductal adenocarcinoma (PDAC). However, little is known about the association between smoking status and prognosis in resected PDAC.All patients who underwent resection for PDAC were identified from two prospective institutional databases. Clinicopathologic data as well as demographics including smoking status were extracted. Survival analysis and multivariable Cox regression modelling was performed. Restricted cubic splines were used for linear data to define cut-off points.Out of 848 patients, 357 (42.1%) received neoadjuvant treatment (NAT), 491 upfront resection (57.9%), and 475 (56%) adjuvant therapy. The median overall survival (OS) was 27.8 months, 36.1 months, and 23.0 months for the entire cohort, after NAT and upfront resection. 464 patients were never smokers (54.7%), 250 former smokers (29.5%), and 134 active smokers (15.8%). In the multivariable model, the interaction of neoadjuvant FOLFIRINOX and active smoking was associated with the highest risk for decreased OS (harzard ratio (HR) 2.35; 95% confidence interval 1.13-4.90) and strongly mitigated the benefit of FOLFIRNOX (HR 0.40; 95% CI 0.25-0.63). Adjusted median OS in NAT patients with FOLFIRINOX was not reached for never and former smokers, compared to 26.2 months in active smokers. Based on the model, a nomogram was generated to illustrate the probability of 5-year survival after PDAC resection.The present study confirms that neoadjuvant FOLFIRINOX is associated with excellent survival and demonstrates that active smoking reduces its benefit. The nomogram can assist in daily clinical practice and emphasises the importance of smoking cessation in patients with PDAC, especially prior to NAT with FOLFIRINOX.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.