Hu H, Qu C, Tian X D, Yang Y M
Department of General Surgery,Peking University First Hospital,Beijing 100034,China.
Zhonghua Wai Ke Za Zhi. 2021 Sep 1;59(9):773-779. doi: 10.3760/cma.j.cn112139-20210507-00202.
To compare the prognosis of patients underwent radical resection for pancreatic ductal adenocarcinoma(PDAC) in Surveillance, Epidemiology, and End Results(SEER) and China Pancreas Data Center(CPDC), and to compare the prognostic factors for PDAC in both databases. The data of patients underwent radical resection for PDAC in CPDC database from January 2016 to December 2017 and SEER database from January 2014 to December 2015 were retrospectively analyzed. The prognosis of patients in both databases was analyzed by the Kaplan-Meier method, Log-rank method, and propensity score matching, and the Cox proportional hazard regression was used to analyze the independent prognosis factors for PDAC. There were 1 977 cases and 2 220 cases of pancreatic cancer that underwent radical resection from CPDC and SEER, respectively. There were more male patients(60.90%,1 204/1 977) than female patients(39.10%,773/1 977) in CPDC, while nearly 1∶1 ratio(male:1 112 cases,female:1108)was observed between male and female in SEER(χ²=48.977,<0.01). The proportion of patients under 45 years old was the smallest in both databases, and the age group with the most significant proportion was 60 to 74 years old. The ratio of patients over 75 years old in the SEER(24.28%,539/2 220) was higher than that of CPDC(7.89%,156/1 977)(χ²=202.090,<0.01), while the proportion of patients between 45 and 59 years old in CPDC(33.69%,666/1 977) was higher than that in SEER(19.77%,439/2 220)(χ²=103.640,<0.01). There were more pancreatic head cancers than body and tail cancers in both databases, and no statistical difference was found in tumor size between the two databases (=2 181 502,=0.740). More positive and examined lymph nodes were found in SEER patients (=3 265 131,=2 954 363,all <0.01); and the proportion of patients who had at least 15 lymph nodes dissected was higher in SEER(63.24%,1 404/2 220)(χ²=532.130,<0.01). There were more patients without neoadjuvant or adjuvant therapy in CPDC(57.16%,1 130/1 977) than that in SEER(24.91%,553/2 220)(χ²=451.390,<0.01). After propensity score matching, the overall survival for CPDC was better than that for SEER(Log-rank test:χ²=4.500,=0.034), and the median overall survival was 24 months and 23 months respectively. Cox regressional analysis showed the common independent prognosis factors in both databases were ≥75 years old, pancreatic head cancer, poorly differentiated and undifferentiated tumors, T stage, N stage(All <0.05). Neoadjuvant or adjuvant therapy was a protective factor in both databases(CPDC:=27.082;SEER:=212.285, all <0.01) and 45 to 59 years old was protective factor in the SEER database(=5.212,=0.020). The data in both databases have a good consistency. However, in terms of data quality, examined lymph nodes count, and neoadjuvant/adjuvant therapy rate, the CPDC differs greatly from the SEER.
比较监测、流行病学和最终结果(SEER)数据库与中国胰腺数据中心(CPDC)中接受胰导管腺癌(PDAC)根治性切除术患者的预后,并比较两个数据库中PDAC的预后因素。回顾性分析2016年1月至2017年12月CPDC数据库和2014年1月至2015年12月SEER数据库中接受PDAC根治性切除术患者的数据。采用Kaplan-Meier法、Log-rank法和倾向得分匹配法分析两个数据库中患者的预后,并采用Cox比例风险回归分析PDAC的独立预后因素。CPDC和SEER分别有1977例和2220例胰腺癌患者接受了根治性切除术。CPDC中男性患者(60.90%,1204/1977)多于女性患者(39.10%,773/1977),而SEER中男性与女性比例接近1∶1(男性:1112例,女性:1108例)(χ²=48.977,P<0.01)。两个数据库中45岁以下患者比例最小,比例最高的年龄组为60至74岁。SEER中75岁以上患者比例(24.28%,539/2220)高于CPDC(7.89%,156/1977)(χ²=202.090,P<0.01),而CPDC中45至59岁患者比例(33.69%,666/1977)高于SEER(19.77%,439/2220)(χ²=103.640,P<0.01)。两个数据库中胰头癌均多于胰体尾癌,两个数据库之间肿瘤大小无统计学差异(F=2.181502,P=0.740)。SEER患者中阳性及检查淋巴结更多(F=3.265131,F=2.954363,均P<0.01);SEER中至少切除15枚淋巴结的患者比例更高(63.24%,1404/2220)(χ²=532.130,P<0.01)。CPDC中未接受新辅助或辅助治疗的患者(57.16%,1130/1977)多于SEER(24.91%,553/2220)(χ²=451.390,P<0.01)。倾向得分匹配后,CPDC的总生存期优于SEER(Log-rank检验:χ²=4.500,P=0.034),中位总生存期分别为24个月和23个月。Cox回归分析显示,两个数据库中共同的独立预后因素为≥75岁、胰头癌、低分化和未分化肿瘤、T分期、N分期(均P<0.05)。新辅助或辅助治疗在两个数据库中均为保护因素(CPDC:F=27.082;SEER:F=212.285,均P<0.01),45至59岁在SEER数据库中为保护因素(F=5.212,P=0.020)。两个数据库中的数据具有良好的一致性。然而,在数据质量、检查淋巴结计数和新辅助/辅助治疗率方面,CPDC与SEER差异很大。