Meng Zibo, Cao Mingsi, Zhang Yushun, Liu Zhiqiang, Wu Shihong, Wu Heshui
Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Institute of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
BMC Gastroenterol. 2019 Apr 24;19(1):59. doi: 10.1186/s12876-019-0975-3.
The latest 8th edition of the AJCC staging system emphasizes the importance of tumor size however, the clinical significance of the combination of tumor location with tumor size remains unknown.
We conducted this study to investigate the prognostic role of tumor location in T1 resectable pancreatic ductal adenocarcinoma (PDAC). Resectable PDAC patients from Surveillance, Epidemiology, and End Results (SEER) database (2004-2014) were selected for the propensity score matching analysis. We used matched cohort to analyze the relationship between clinicopathologic features and survival of patients.
Eight thousand, four hundred nine patients were included in the propensity score matching analysis and 4571 patients were selected for final analysis. In T1 patients, the patients with pancreatic head tumor had worse prognosis compared to the patients with body/tail tumors. Multivariate analysis result showed that pancreatic body/tail location was an independent indicator for better chances of survival in T1 PDAC patients (hazard ratio, 0.69; 95%CI, 0.52-0.93; P = 0.01). The modified staging system was more efficient than the AJCC 8th staging system.
Modified staging system exhibited a good assessment of the survival rate. The tumor location is a good prognostic indicator for T1 resectable PDAC patients. Modification of T1 subgroup according to tumor location exhibited favorable survival prediction effects.
美国癌症联合委员会（AJCC）分期系统的最新第8版强调了肿瘤大小的重要性，然而，肿瘤位置与肿瘤大小相结合的临床意义仍不清楚。
我们开展这项研究以调查肿瘤位置在T1期可切除胰腺导管腺癌（PDAC）中的预后作用。从监测、流行病学和最终结果（SEER）数据库（2004 - 2014年）中选取可切除的PDAC患者进行倾向评分匹配分析。我们使用匹配队列分析患者的临床病理特征与生存之间的关系。
8409例患者纳入倾向评分匹配分析，4571例患者被选入最终分析。在T1期患者中，胰头肿瘤患者的预后比体部/尾部肿瘤患者差。多因素分析结果显示，胰腺体部/尾部位置是T1期PDAC患者生存机会更好的独立指标（风险比，0.69；95%可信区间，0.52 - 0.93；P = 0.01）。改良分期系统比AJCC第8版分期系统更有效。
改良分期系统对生存率有良好的评估。肿瘤位置是T1期可切除PDAC患者的良好预后指标。根据肿瘤位置对T1亚组进行改良显示出良好的生存预测效果。
