Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Eur J Surg Oncol. 2021 Mar;47(3 Pt B):613-619. doi: 10.1016/j.ejso.2020.09.008. Epub 2020 Sep 16.
Several prognostic scoring systems based on cancer-related inflammation have been developed. We aimed to evaluate the efficacy of a novel physiobiological parameter-based grading system (PGS) for predicting the long-term prognosis after curative-intent surgery for pancreatic ductal adenocarcinoma.
One-hundred fifty-nine consecutive patients with pancreatic ductal adenocarcinoma were enrolled. Univariate and multivariate analyses were performed to identify variables associated with overall survival and recurrence-free survival. Patients were stratified according to the PGS score with a cut-off value of 40.5 being estimated by receiver-operating characteristic curve analysis. Propensity score matching analysis (PSM) was performed to compare between patients with low and high scores in the physiobiological parameter-based grading system.
Univariate analysis showed that CEA elevation (p = 0.032), tumor size ≥20 mm (p < 0.001), lymph node metastasis (p < 0.001), high-PGS (p < 0.001), CA19-9 elevation (p < 0.001), Prognostic nutritious index (PNI) ≤40 (p = 0.002) and positive Glasgow prognostic score (GPS) (p = 0.001) were risk factors for poor overall survival. CEA elevation (p = 0.006), Tumor size ≥20 mm (p < 0.001), lymph node metastasis (p < 0.001), high-PGS (p < 0.001), CA19-9 elevation (p < 0.001), PNI ≤40 (p = 0.017) and positive GPS (p < 0.001) were identified as risk factors for poor recurrence-free survival. The multivariate analysis revealed that tumor size ≥20 mm (p = 0.007, p = 0.008, respectively) and high PGS score (p = 0.041, p = 0.018, respectively) were independently associated with poor overall survival and recurrence-free survival. Patients with high-PGS showed a significantly worse long-term prognosis even after PSM.
The PGS is a novel nomogram that could effectively predict long-term outcomes following curative surgery in patients with pancreatic ductal adenocarcinoma.
已经开发出了几种基于癌症相关炎症的预后评分系统。我们旨在评估一种新的基于生理生物参数的分级系统（PGS）预测胰腺导管腺癌根治性手术后长期预后的疗效。
纳入 159 例连续胰腺导管腺癌患者。进行单因素和多因素分析，以确定与总生存和无复发生存相关的变量。根据通过受试者工作特征曲线分析估计的 40.5 分的截断值，根据 PGS 评分对患者进行分层。进行倾向评分匹配分析（PSM），以比较生理生物参数分级系统中低评分和高评分患者之间的差异。
单因素分析显示，CEA 升高（p=0.032）、肿瘤大小≥20mm（p<0.001）、淋巴结转移（p<0.001）、高 PGS（p<0.001）、CA19-9 升高（p<0.001）、预后营养指数（PNI）≤40（p=0.002）和阳性格拉斯哥预后评分（GPS）（p=0.001）是总生存不良的危险因素。CEA 升高（p=0.006）、肿瘤大小≥20mm（p<0.001）、淋巴结转移（p<0.001）、高 PGS（p<0.001）、CA19-9 升高（p<0.001）、PNI≤40（p=0.017）和阳性 GPS（p<0.001）是无复发生存不良的危险因素。多因素分析显示，肿瘤大小≥20mm（p=0.007、p=0.008）和高 PGS 评分（p=0.041、p=0.018）与总生存和无复发生存不良独立相关。即使在 PSM 后，高 PGS 患者的长期预后也明显较差。
PGS 是一种新的列线图，可以有效地预测胰腺导管腺癌根治性手术后的长期结局。
