转化为简体中文并保留原始句子结构： 对于转移性胰腺腺癌（PDAC）的化疗效果有限，但存活结果有所不同。缺乏可靠的预测性反应生物标志物来指导患者治疗。在SIEGE随机前瞻性临床试验中，在开始同步或顺序nab-紫杉醇+吉西他滨化疗治疗之前，评估了146名转移性PDAC患者的患者表现状态，肿瘤负担（通过具有或不具有肝转移来确定），血浆蛋白生物标志物（CA19-9，白蛋白，C-反应蛋白和中性粒细胞）和循环肿瘤DNA（ctDNA），以及治疗的前8周。将其与客观反应、1年内死亡和总生存（OS）进行相关性分析。在调整感兴趣的不同生物标志物后，初始较差的患者表现状态、肝转移的存在和可以检测到的mutKRAS ctDNA均与更糟的OS相关。8周的客观反应还与OS相关（P=0.026）。在治疗期间和第一次反应评估之前测量的血浆生物标志物确定，在4周内白蛋白下降≥10%预示着更差的OS（HR 4.75，95% CI 1.43-16.94，P=0.012），而mutKRAS ctDNA的纵向评估与OS的任何关联不明确（β=0.024，P=0.057）。可测量的患者变量可以帮助预测用于治疗转移性PDAC的组合化疗的结果。 mutKRAS ctDNA作为指导治疗的工具的作用需要进一步探索。 ISRCTN71070888; ClinialTrials.gov（NCT03529175）。©2023年作者。

Chemotherapy for metastatic pancreatic adenocarcinoma (PDAC) offers limited benefits, but survival outcomes vary. Reliable predictive response biomarkers to guide patient management are lacking.Patient performance status, tumour burden (determined by the presence or absence of liver metastases), plasma protein biomarkers (CA19-9, albumin, C-reactive protein and neutrophils) and circulating tumour DNA (ctDNA) were assessed in 146 patients with metastatic PDAC prior to starting either concomitant or sequential nab-paclitaxel + gemcitabine chemotherapy in the SIEGE randomised prospective clinical trial, as well as during the first 8 weeks of treatment. Correlations were made with objective response, death within 1 year and overall survival (OS).Initial poor patient performance status, presence of liver metastases and detectable mutKRAS ctDNA all correlated with worse OS after adjusting for the different biomarkers of interest. Objective response at 8 weeks also correlated with OS (P = 0.026). Plasma biomarkers measured during treatment and prior to the first response assessment identified ≥10% decrease in albumin at 4 weeks predicted for worse OS (HR 4.75, 95% CI 1.43-16.94, P = 0.012), while any association of longitudinal evaluation of mutKRAS ctDNA with OS was unclear (β = 0.024, P = 0.057).Readily measurable patient variables can aid the prediction of outcomes from combination chemotherapy used to treat metastatic PDAC. The role of mutKRAS ctDNA as a tool to guide treatment warrants further exploration.ISRCTN71070888; ClinialTrials.gov (NCT03529175).© 2023. The Author(s).