既往急性胰腺炎病史可预测可切除性胰腺导管腺癌患者的生存不良。

Prior history of acute pancreatitis predicts poor survival in patients with resectable pancreatic ductal adenocarcinoma.

机构信息

Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China; Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China.

出版信息

Pancreatology. 2020 Jun;20(4):716-721. doi: 10.1016/j.pan.2020.02.016. Epub 2020 Feb 27.

DOI:10.1016/j.pan.2020.02.016

PMID:32249060

Abstract

BACKGROUND/OBJECTIVES: Mounting evidence has suggested that acute pancreatitis (AP) is a risk factor for pancreatic ductal adenocarcinoma (PDAC), but its role in survival in PDAC patients was rarely investigated. The objective was to investigate the association of a history of AP with survival among PDAC patients who underwent surgical resection.

METHODS

A retrospective cohort study comprising 632 patients who were diagnosed with resectable PDAC was conducted. Survival was evaluated by history of AP prior to a diagnosis of PDAC using Kaplan-Meier methods and log-rank tests. Multivariate analyses for mortality were estimated using the Cox proportional hazards model. Propensity score matching methods were used to balance the difference of clinical characteristics between patients with and without AP history.

RESULTS

The log-rank tests showed that patients with a history of AP had a worse overall survival than those without a history of AP (p = 0.006). The multivariable-adjusted hazard ratio (HR) for mortality comparing participants with AP to those without AP was 1.808 (95% CI: 1.241-2.632, p = 0.002). Patients with a recent history of AP (<2 years), rather than patients with a remote history of AP (≥2 years), were found to have significantly worse survival (p = 0.014) than those without a history of AP. After adjusted for PSM, history of AP remained an independent survival predictor of PDAC following surgical resection.

CONCLUSIONS

Our findings indicate that a history of AP, especially a recent history of AP, is associated with poor survival among patients with resectable pancreatic ductal adenocarcinoma.

摘要

背景/目的：越来越多的证据表明急性胰腺炎（AP）是胰腺导管腺癌（PDAC）的危险因素，但很少有研究探讨其在 PDAC 患者生存中的作用。本研究旨在探讨 AP 病史与接受手术切除的 PDAC 患者生存之间的关系。

方法

对 632 例诊断为可切除 PDAC 的患者进行了回顾性队列研究。采用 Kaplan-Meier 方法和对数秩检验评估 AP 病史与 PDAC 诊断前生存的关系。采用 Cox 比例风险模型对死亡率进行多变量分析。采用倾向评分匹配方法平衡有无 AP 病史患者的临床特征差异。

结果

对数秩检验显示，有 AP 病史的患者总生存情况较无 AP 病史的患者差（p=0.006）。多变量调整后的死亡率风险比（HR）比较 AP 组与无 AP 组的 HR 为 1.808（95%CI：1.241-2.632，p=0.002）。与无 AP 病史的患者相比，近期（<2 年）AP 病史的患者生存情况明显更差（p=0.014），而远期（≥2 年）AP 病史的患者生存情况与无 AP 病史的患者相似。经过 PSM 调整后，AP 病史仍然是手术切除后 PDAC 患者生存的独立预测因素。