ALB and neoplasm: We also identified independent prognostic factors in the upfront surgery group, including tumor size ≥ 35 mm, CA19-9 level ≥ 250 U/mL, DUPAN-2 level ≥ 750 U/mL, albumin level ≤ 3.5 g/dL, and neutrophil-to-lymphocyte ratio ≥ 3.5.