胰头与胰体/尾部黏液腺癌不同的生存及临床病理特征

Dissimilar survival and clinicopathological characteristics of mucinous adenocarcinoma located in pancreatic head and body/tail.

作者信息

Li Zheng, Zhang Xiao-Jie, Sun Chong-Yuan, Li Ze-Feng, Fei He, Zhao Dong-Bing

机构信息

Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/ National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

出版信息

World J Gastrointest Surg. 2023 Jun 27;15(6):1178-1190. doi: 10.4240/wjgs.v15.i6.1178.

DOI:10.4240/wjgs.v15.i6.1178

PMID:37405087

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10315121/

Abstract

BACKGROUND

Growing evidence shows that pancreatic tumors in different anatomical locations have different characteristics, which have a significant impact on prognosis. However, no study has reported the differences between pancreatic mucinous adenocarcinoma (PMAC) in the head the body/tail of the pancreas.

AIM

To investigate the differences in survival and clinicopathological characteristics between PMAC in the head and body/tail of pancreas.

METHODS

A total of 2058 PMAC patients from the Surveillance, Epidemiology, and End Results database diagnosed between 1992 and 2017 were retrospectively reviewed. We divided the patients who met the inclusion criteria into pancreatic head group (PHG) and pancreatic body/tail group (PBTG). The relationship between two groups and risk of invasive factors was identified using logistic regression analysis. Kaplan-Meier analysis and Cox regression analysis were conducted to compare the overall survival (OS) and cancer-specific survival (CSS) of two patient groups.

RESULTS

In total, 271 PMAC patients were included in the study. The 1-year, 3-year, and 5-year OS rates of these patients were 51.6%, 23.5%, and 13.6%, respectively. The 1-year, 3-year, and 5-year CSS rates were 53.2%, 26.2%, and 17.4%, respectively. The median OS of PHG patients was longer than that of PBTG patients (18 7.5 mo, < 0.001). Compared to PHG patients, PBTG patients had a greater risk of metastases [odds ratio (OR) = 2.747, 95% confidence interval (CI): 1.628-4.636, < 0.001] and higher staging (OR = 3.204, 95% CI: 1.895-5.415, < 0.001). Survival analysis revealed that age < 65 years, male sex, low grade (G1-G2), low stage, systemic therapy, and PMAC located at the pancreatic head led to longer OS and CSS (all < 0.05). The location of PMAC was an independent prognostic factor for CSS [hazard ratio (HR) = 0.7, 95%CI: 0.52-0.94, = 0.017]. Further analysis demonstrated that OS and CSS of PHG were significantly better than PBTG in advanced stage (stage III-IV).

CONCLUSION

Compared to the pancreatic body/tail, PMAC located in the pancreatic head has better survival and favorable clinicopathological characteristics.

摘要

背景

越来越多的证据表明，胰腺不同解剖部位的肿瘤具有不同特征，这对预后有重大影响。然而，尚无研究报道胰腺头部与体尾部黏液性腺癌（PMAC）之间的差异。

目的

探讨胰腺头部与体尾部PMAC在生存及临床病理特征方面的差异。

方法

回顾性分析监测、流行病学与最终结果（SEER）数据库中1992年至2017年间诊断的2058例PMAC患者。将符合纳入标准的患者分为胰头组（PHG）和胰体/尾组（PBTG）。采用逻辑回归分析确定两组与侵袭性因素风险之间的关系。进行Kaplan-Meier分析和Cox回归分析，比较两组患者的总生存期（OS）和癌症特异性生存期（CSS）。

结果

本研究共纳入271例PMAC患者。这些患者的1年、3年和5年OS率分别为51.6%、23.5%和13.6%。1年、3年和5年CSS率分别为53.2%、26.2%和17.4%。PHG患者的中位OS长于PBTG患者（18对7.5个月，P<0.001）。与PHG患者相比，PBTG患者发生转移的风险更高[比值比（OR）=2.747，95%置信区间（CI）：1.628 - 4.636，P<0.001]，且分期更高（OR = 3.204，95%CI：1.895 - 5.415，P<0.001）。生存分析显示，年龄<65岁、男性、低分级（G1 - G2）、低分期、全身治疗以及位于胰头的PMAC可使OS和CSS更长（均P<0.05）。PMAC的位置是CSS的独立预后因素[风险比（HR）=0.7，95%CI：0.52 - 0.94，P = 0.017]。进一步分析表明，在晚期（III - IV期），PHG的OS和CSS显著优于PBTG。