Chen Li, Jia Lanning, Tian Zhigang, Yang Yang, Zhao Ke
Department of General Surgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China.
Department of Anorectal Surgery, Anorectal Surgery Center, Union's Hospital of Tianjin, Tianjin, China.
Int J Endocrinol. 2022 Apr 18;2022:6469740. doi: 10.1155/2022/6469740. eCollection 2022.
The incidence of pancreatic cancer continues to rise globally, with pancreatic head cancer accounting for nearly 60-70%. Pancreatic head cancer occurs mainly in people over the age of 60, and its morbidity and mortality increase with age. We investigated whether these elderly patients with nondistant metastases would benefit more from expanded pancreaticoduodenectomy (EPD) compared with standard pancreaticoduodenectomy (SPD).
3317 elderly patients with pancreatic head cancer from the SEER database were included in the study based on the inclusion and exclusion criteria. These patients were divided into a nonsurgical group and surgical group (including EPD and SPD). Univariate and multivariate Cox proportional hazards models were applied to identify the independent risk factors for cancer-specific survival (CSS). The survival differences between the nonsurgical group and surgical group were compared. Propensity score matching (PSM) methods were applied to balance covariates and reduce the interference of confounding variables. The two groups of patients were matched in a 1 : 1 ratio, and the covariates between the two groups were compared to verify the matching validity. The survival difference in different groups was compared after the matching analysis.
3317 enrolled patients were divided into the surgical group ( = 984) and nonsurgical group ( = 2333). Before PSM, there were significant differences in overall survival (OS) and CSS between the nonsurgical group and surgical group (median OS: 8 months vs. 20 months, < 0.001; median CSS: 8 months vs. 22 months, < 0.001). The multivariate CSS Cox regression analysis demonstrated surgery is an independent risk factor. However, no significant differences were founded between the SPD and EPD groups (median OS: 20 months vs. 22 months, =0.636; median CSS: 22 months vs. 22 months, =0.270). After PSM, there were also no significant differences in OS and CSS between the SPD and EPD groups (median OS: 23 months vs. 18 months, =0.415; median CSS: 26 months vs. 18 months, =0.329).
This study uses PSM to evaluate the effects of EPD and SPD for elderly patients with nondistant metastatic pancreatic head adenocarcinoma. It found that surgery is an independent prognostic factor, but expanded surgery has no survival advantage for these patients, whereas SPD provides a better survival advantage than EPD. SPD is a reasonable treatment option for these patients.
全球范围内胰腺癌的发病率持续上升，其中胰头癌占近60%-70%。胰头癌主要发生在60岁以上人群，其发病率和死亡率随年龄增长而增加。我们研究了与标准胰十二指肠切除术（SPD）相比，这些无远处转移的老年患者接受扩大胰十二指肠切除术（EPD）是否能获得更多益处。
根据纳入和排除标准，将SEER数据库中3317例老年胰头癌患者纳入研究。这些患者被分为非手术组和手术组（包括EPD和SPD）。应用单因素和多因素Cox比例风险模型确定癌症特异性生存（CSS）的独立危险因素。比较非手术组和手术组之间的生存差异。应用倾向得分匹配（PSM）方法平衡协变量并减少混杂变量的干扰。两组患者按1:1比例匹配，并比较两组之间的协变量以验证匹配有效性。匹配分析后比较不同组的生存差异。
3317例纳入患者分为手术组（n=984）和非手术组（n=2333）。在PSM之前，非手术组和手术组之间的总生存期（OS）和CSS存在显著差异（中位OS：8个月对20个月，P<0.001；中位CSS：8个月对22个月，P<0.001）。多因素CSS Cox回归分析表明手术是一个独立危险因素。然而，SPD组和EPD组之间未发现显著差异（中位OS：20个月对22个月，P=0.
