Khalid Abdullah, Aveson Victoria, Pasha Shamsher A, Demyan Lyudmyla, Standring Oliver, Newman Elliot, King Daniel A, DePeralta Danielle, Gholami Sepideh, Weiss Matthew J, Melis Marcovalerio
Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr. Manhasset, Manhasset, NY, 11030, USA.
Department of Surgery, UT Health San Antonio, San Antonio, TX, 78229, USA.
J Gastrointest Cancer. 2025 May 31;56(1):126. doi: 10.1007/s12029-025-01254-4.
The Environmental Quality Index (EQI), a composite measure of county-level environmental burden, has been linked to cancer incidence and disease progression. We evaluated the association between EQI and clinical characteristics and outcomes among patients undergoing pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).
We conducted a retrospective cohort study of PDAC patients who underwent PD between 2014 and 2023. Patients were stratified into low, moderate, or high EQI groups. Multinomial regression models were used to assess associations between EQI levels and clinical variables, using the low EQI group as the reference.
Among the 137 patients with PDAC who underwent PD, 37 (27.1%) were in the low, 42 (30.6%) in the moderate, and 58 (42.3%) in the high EQI groups. The study identified significant associations in high EQI groups: race (minority vs. white patients: RR 2.44, p = 0.044); diabetes mellitus prevalence (RR 3.12, 95% CI 1.30-7.49, p = 0.011), tumor size > 5 cm (RR 1.53, p = 0.048), history of other types of cancer (RR 1.64, p = 0.038), longer time-to-treatment (RR 1.96, p = 0.041), and ICU stay > 3 days (RR 1.95, p = 0.013), compared to the low EQI group. No significant differences were observed in severe post-operative complications, mortality rates, or median overall survival across groups (mOS: 20.2 months for low, 15.2 months for moderate, and 14.2 months for high EQI, respectively, p = 0.210).
Patients residing in areas with poor environmental quality had higher comorbidity burden and delays in treatment, though EQI was not significantly associated with surgical or survival outcomes.
环境质量指数（EQI）是衡量县级环境负担的综合指标，已被证明与癌症发病率和疾病进展有关。我们评估了EQI与接受胰十二指肠切除术（PD）治疗胰腺导管腺癌（PDAC）患者的临床特征及预后之间的关联。
我们对2014年至2023年间接受PD的PDAC患者进行了一项回顾性队列研究。患者被分为低、中、高EQI组。采用多项回归模型，以低EQI组为参照，评估EQI水平与临床变量之间的关联。
在137例接受PD的PDAC患者中，低EQI组37例（27.1%），中EQI组42例（30.6%），高EQI组58例（42.3%）。研究发现高EQI组存在显著关联：种族（少数族裔与白人患者：相对风险[RR] 2.44，p = 0.044）；糖尿病患病率（RR 3.12，95%置信区间[CI] 1.30 - 7.49，p = 0.011），肿瘤大小>5 cm（RR 1.53，p = 0.048），其他类型癌症病史（RR 1.64，p = 0.038），治疗延迟时间更长（RR 1.96，p = 0.041），以及入住重症监护病房（ICU）>3天（RR 1.95，p = 0.013），与低EQI组相比。各组在严重术后并发症、死亡率或中位总生存期方面未观察到显著差异（中位总生存期[mOS]：低EQI组为20.2个月，中EQI组为15.2个月，高EQI组为14.2个月，p = 0.210）。
居住在环境质量差地区的患者合并症负担更高且治疗延迟，尽管EQI与手术或生存结局无显著关联。
