Huang Jinsheng, Li Xujia, Jiang Qi, Qiu Huijuan, Rong Yuming, Cui Bokang, Guo Guifang
VIP Department, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China.
State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China.
Evid Based Complement Alternat Med. 2023 Feb 21;2023:2916974. doi: 10.1155/2023/2916974. eCollection 2023.
Negative regional lymph nodes do not indicate a lack of distant metastasis. A considerable number of patients with negative regional lymph node pancreatic cancer will skip the step of regional lymph node metastasis and directly develop distant metastasis.
We retrospectively analyzed the clinicopathological characteristics of patients with negative regional lymph node pancreatic cancer and distant metastasis in the Surveillance, Epidemiology, and End Results database from 2010 to 2015. Multivariate logistic analysis and Cox analysis were used to determine the independent risk factors that promoted distant metastasis and the 1-, 2-, and 3-year cancer-specific survival in this subgroup.
Sex, age, pathological grade, surgery, radiotherapy, race, tumor location, and tumor size were significantly correlated with distant metastasis ( < 0.05). Among these factors, pathological grade II and above, tumor site other than the pancreatic head, and tumor size >40 mm were independent risk factors for distant metastasis; age ≥60 years, tumor size ≤21 mm, surgery, and radiation were protective factors against distant metastasis. Age, pathological grade, surgery, chemotherapy, and metastasis site were identified as predictors of survival. Among them, age ≥40 years, pathological grade II and above, and multiple distant metastasis were considered independent risk factors for cancer-specific survival. Surgery and chemotherapy were considered protective factors for cancer-specific survival. The prediction performance of the nomogram was significantly better than that of the traditional American Joint Committee on Cancer tumor, node, metastasis staging system. We also established an online dynamic nomogram calculator, which can predict the survival rate of patients at different follow-up time points.
Pathological grade, tumor location, and tumor size were independent risk factors for distant metastasis in pancreatic ductal adenocarcinoma with negative regional lymph nodes. Older age, smaller tumor size, surgery, and radiotherapy were protective factors against distant metastasis. A new nomogram that was constructed could effectively predict cancer-specific survival in pancreatic ductal adenocarcinoma with negative regional lymph nodes and distant metastasis. Furthermore, an online dynamic nomogram calculator was established.
区域淋巴结阴性并不意味着没有远处转移。相当一部分区域淋巴结阴性的胰腺癌患者会跳过区域淋巴结转移阶段，直接发生远处转移。
我们回顾性分析了2010年至2015年监测、流行病学和最终结果数据库中区域淋巴结阴性且发生远处转移的胰腺癌患者的临床病理特征。采用多因素逻辑回归分析和Cox分析来确定促进远处转移的独立危险因素以及该亚组患者1年、2年和3年的癌症特异性生存率。
性别、年龄、病理分级、手术、放疗、种族、肿瘤位置和肿瘤大小与远处转移显著相关（<0.05）。在这些因素中，病理分级为II级及以上、肿瘤位于胰头以外部位以及肿瘤大小>40 mm是远处转移的独立危险因素；年龄≥60岁、肿瘤大小≤21 mm、手术和放疗是预防远处转移的保护因素。年龄、病理分级、手术、化疗和转移部位被确定为生存的预测因素。其中，年龄≥40岁、病理分级为II级及以上和多处远处转移被认为是癌症特异性生存的独立危险因素。手术和化疗被认为是癌症特异性生存的保护因素。列线图的预测性能明显优于传统的美国癌症联合委员会肿瘤、淋巴结、转移分期系统。我们还建立了一个在线动态列线图计算器，它可以预测不同随访时间点患者的生存率。
病理分级、肿瘤位置和肿瘤大小是区域淋巴结阴性的胰腺导管腺癌远处转移的独立危险因素。年龄较大、肿瘤较小、手术和放疗是预防远处转移的保护因素。构建的新列线图可以有效预测区域淋巴结阴性且发生远处转移的胰腺导管腺癌患者特定癌症的生存率。此外，还建立了一个在线动态列线图计算器。
