The final results of this randomized clinical trial of 493 patients with pancreatic ductal adenocarcinoma (PDAC) showed that treatment with modified FOLFIRINOX as opposed to gemcitabine significantly increased overall survival (median survival, 53.5 vs. 35.5 months). Younger age, well-differentiated tumors, lower-stage tumors, larger-volume centers, and finishing the prescribed course of therapy all predicted better survival; early disease relapse was an adverse prognostic factor for overall survival from relapse.