Zhang Jingchang, Li Jianbiao, Deng Huiting, Zhao Yongfu, Zhang Ye
Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, 300110, China.
Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin, 300110, China.
World J Surg Oncol. 2025 Jul 16;23(1):281. doi: 10.1186/s12957-025-03940-w.
This study aimed to identify independent prognostic factors for advanced unresectable pancreatic ductal adenocarcinoma (PDAC) and construct a nomogram-based prediction model. The efficacy of different chemotherapy regimens was evaluated based on metabolic risk levels.
Clinical data from 276 patients with unresectable PDAC treated between 2020 and 2022 were retrospectively analyzed. Cox proportional hazards regression identified prognostic factors, and survival analysis was performed using Kaplan-Meier methods. A nomogram was developed, and ROC analysis assessed its predictive performance. Two-way ANOVA evaluated chemotherapy efficacy, and TCGA transcriptomic data explored metabolic correlations.
Metabolic syndrome (MetS) and distant metastasis were independent prognostic factors. Patients with MetS had significantly shorter survival. The nomogram showed good discrimination (AUC: 0.815 training, 0.793 validation). Patients without MetS had better outcomes with FOLFIRINOX or GS regimens. Transcriptomic analysis revealed metabolic pathways linked to PDAC progression.
MetS and distant metastasis significantly impact PDAC prognosis. Patients without MetS benefit more from specific chemotherapy regimens. Our predictive model may aid personalized treatment strategies.
本研究旨在确定晚期不可切除胰腺导管腺癌（PDAC）的独立预后因素，并构建基于列线图的预测模型。基于代谢风险水平评估不同化疗方案的疗效。
回顾性分析2020年至2022年间接受治疗的276例不可切除PDAC患者的临床资料。Cox比例风险回归确定预后因素，并采用Kaplan-Meier方法进行生存分析。开发了列线图，并通过ROC分析评估其预测性能。双向方差分析评估化疗疗效，TCGA转录组数据探索代谢相关性。
代谢综合征（MetS）和远处转移是独立的预后因素。患有MetS的患者生存期明显较短。列线图显示出良好的区分度（训练集AUC：0.815，验证集AUC：0.793）。没有MetS的患者接受FOLFIRINOX或GS方案治疗的预后更好。转录组分析揭示了与PDAC进展相关的代谢途径。
MetS和远处转移显著影响PDAC预后。没有MetS的患者从特定化疗方案中获益更多。我们的预测模型可能有助于制定个性化治疗策略。
