Zhang Wei, Xu Lin, Che Xu
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2021 Nov 4;11:766071. doi: 10.3389/fonc.2021.766071. eCollection 2021.
In this study, we retrieved the data available in the Surveillance, Epidemiology, and End Results database to identify the prognostic factors for patients with pancreatic head cancer who had undergone pancreaticoduodenectomy and developed a prediction model for clinical reference.
We screened the data between 1973 and 2015. Propensity score matching (PSM) was used to control for the confounding factors. Kaplan-Meier (log-rank test) curves were used to compare the survival rates. A nomogram was established using multifactorial Cox regression.
In total, 4099 patients were identified. Their median survival was 22 months, with 74.2%, 36.5%, and 26.2% survival after 1, 3, and 5 years, respectively. The median cancer-specific survival was 24.0 months, with 71.1%, 32.6%, and 21.9% survival after 1, 3, and 5 years, respectively. The results of the Cox proportional risk regression showed that age, insurance status, gender, histological type, degree of tissue differentiation, T and N stages, tumor size, extent of regional lymph node dissection, and postoperative radiotherapy or chemotherapy are independent factors affecting prognosis. PSM was used twice to eliminate any bias from the unbalanced covariates in the raw data. After PSM, the patients who had received postoperative radiotherapy were found to have a better survival prognosis and disease-specific survival prognosis than those who had not received radiotherapy [HR = 0.809, 95% CI (0.731-0.894), < 0.001 and HR = 0.814, 95% CI (0.732-0.904), < 0.001; respectively]. A similar result was observed for the patients who had received postoperative chemotherapy those who had not [HR = 0.703, 95% CI (0.633-0.78), < 0.001 and HR = 0.736, 95% CI (0.658-0.822), < 0.001, for survival and disease-specific survival prognoses, respectively]. Finally, the β coefficients of the Cox proportional risk regression were used to establish a nomogram.
Age, insurance status, gender, histological type, degree of differentiation, T and N stages, tumor size, regional lymph node dissection, and postoperative radiotherapy or chemotherapy are factors affecting the prognosis in pancreatic head cancer after pancreaticoduodenectomy. Postoperative radiotherapy and chemotherapy can improve patient survival. These still need to be further validated in the future.
在本研究中，我们检索了监测、流行病学和最终结果数据库中的可用数据，以确定接受胰十二指肠切除术的胰头癌患者的预后因素，并建立一个预测模型以供临床参考。
我们筛选了1973年至2015年的数据。采用倾向评分匹配（PSM）来控制混杂因素。使用Kaplan-Meier（对数秩检验）曲线比较生存率。使用多因素Cox回归建立列线图。
共确定了4099例患者。他们的中位生存期为22个月，1年、3年和5年后的生存率分别为74.2%、36.5%和26.2%。癌症特异性中位生存期为24.0个月，1年、3年和5年后的生存率分别为71.1%、32.6%和21.9%。Cox比例风险回归结果显示，年龄、保险状况、性别、组织学类型、组织分化程度、T和N分期、肿瘤大小、区域淋巴结清扫范围以及术后放疗或化疗是影响预后的独立因素。使用PSM两次以消除原始数据中不平衡协变量的任何偏差。PSM后，发现接受术后放疗的患者比未接受放疗的患者具有更好的生存预后和疾病特异性生存预后[HR = 0.809，95% CI（0.731 - 0.894），< 0.001和HR = 0.814，95% CI（0.732 - 0.904），< 0.001；分别]。对于接受术后化疗的患者与未接受化疗的患者也观察到类似结果[生存率和疾病特异性生存预后的HR分别为0.703，95% CI（0.633 - 0.78），< 0.001和HR = 0.736，95% CI（0.658 - 0.822），< 0.001]。最后，使用Cox比例风险回归的β系数建立列线图。
年龄、保险状况、性别、组织学类型、分化程度、T和N分期、肿瘤大小、区域淋巴结清扫以及术后放疗或化疗是影响胰十二指肠切除术后胰头癌预后的因素。术后放疗和化疗可改善患者生存。这些仍需要在未来进一步验证。
