Transplant Center, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
Hepatobiliary Pancreat Dis Int. 2019 Dec;18(6):569-575. doi: 10.1016/j.hbpd.2019.06.007. Epub 2019 Jun 26.
Due to the clinically unapparent course the entity of left-sided pancreatic adenocarcinoma is often diagnosed at advanced stages, resulting in small numbers of patients qualifying for pancreatectomy. This study strives to develop a prognostic model for survival after left-sided pancreatic resection.
A total of 54 patients were analyzed. Pre- and intra-operative predictive factors for 18-month mortality were identified with multivariable binary logistic regression analysis and compiled into a prognostic model. The applicability was evaluated by assessment of the area under the receiver operating characteristic curve (AUROC). The model was internally validated applying a randomized backwards bootstrapping analysis.
The 18-month mortality rate was 74.1% (n = 40). Mean survival was 19.1 months. A prognostic model for 18-month mortality after left sided-pancreatectomy showed an AUROC >0.800: 18-month mortality risk in% = Exp(Y) / (1 + Exp(Y)) with y= -0.927 + (1.724, if CA 19-9 elevated, otherwise 0) + (1.212 × number of intra-operative transfused packed red blood cells) + (2.771, if prior abdominal surgery, otherwise 0) - (3.612, if gastric resection, otherwise 0) This model was internally validated in 40 randomized backwards bootstrapping steps with AUROCs ranging from 0.757 to 0.971.
The 18-month mortality risk for patients after left-sided pancreatectomy for adenocarcinoma of the pancreatic body can be assessed with the number of intra-operatively transfused packed red blood cells, elevated CA 19-9 levels, additional gastric resection and prior abdominal surgeries in the patient's history.
由于左侧胰腺腺癌的临床病程不明显，因此该疾病通常在晚期才被诊断出来，导致只有少数患者符合接受胰腺切除术的条件。本研究旨在为左侧胰腺切除术后的生存建立一个预后模型。
共分析了 54 名患者。通过多变量二项逻辑回归分析确定了 18 个月死亡率的术前和术中预测因素，并将其纳入预后模型。通过评估接受者操作特征曲线（AUROC）下的面积来评估适用性。通过随机向后 bootstrapping 分析对内进行了模型验证。
18 个月的死亡率为 74.1%（n=40）。平均生存时间为 19.1 个月。左侧胰腺切除术后 18 个月死亡率的预后模型 AUROC>0.800：18 个月死亡率风险（%）=Exp(Y)/(1+Exp(Y))，其中 y=-0.927+(1.724，CA 19-9 升高时，否则为 0) +(1.212×术中输注的红细胞数量) +(2.771，有腹部手术史时，否则为 0)- (3.612，有胃切除术史时，否则为 0)。该模型通过 40 次随机向后 bootstrapping 步骤进行了内部验证，AUROCs 范围为 0.757 至 0.971。
对于接受胰腺体腺癌左侧胰腺切除术的患者，术中输注的红细胞数量、CA 19-9 水平升高、附加的胃切除术和患者病史中的先前腹部手术可用于评估 18 个月死亡率风险。
