Evaluation of postoperative prognosis and related risk factors in patients with pancreatic head cancer

doi:10.3877/cma.j.issn.1674-0793.2021.05.003

Abstract

Abstract:

Objective

To evaluate the prognosis of patients with pancreatic head cancer undergoing radical surgery, and to analyze the related factors affecting the prognosis, in order to provide reference for improving the survival rate.

Methods

The clinical data and follow-up of 167 patients with resectable or borderline resectable pancreatic head cancer admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2015 to December 2019 were retrospectively analyzed. Kaplan-Meier method plotted the survival curve, Log-rank test was used for survival comparison, Multivariate Cox regression was used to analyze the prognostic factors, and the best cut-off value of lymph node parameters was calculated by X-tile software.

Results

All the patients successfully completed the operation, 2 cases (1.2%) died during the perioperative period, and the other patients were followed up. The overall median survival time was 17 months. The 1-, 2- and 3-year overall survival rates were 59.3%, 36.5% and 25.2% respectively. Low tumor differentiation (HR=1.708, 95% CI: 1.147-2.543) and lymph node positive rate > 0.1 (HR=2.029, 95% CI: 1.069-3.853) were independent risk factors affecting the prognosis of patients with pancreatic head cancer.

Conclusions

The prognosis of patients with pancreatic head cancer undergoing radical surgery is better. The lower the degree of tumor differentiation and the higher the positive rate of lymph nodes, the worse the prognosis. Moreover, the predictive value of lymph node positive rate for prognosis is better than that of lymph node positive number.

Key words: Pancreatic head carcinoma, Pancreatoduodenectomy, TNM classification, Lymph node dissection, Lymph node positive rate, Tumor differentiation, Prognosis

Junming Xu, Xinxue Zhang, Shuang Cao, Zhe Liu, Jun Ma, Jiantao Kou, Qiang He. Evaluation of postoperative prognosis and related risk factors in patients with pancreatic head cancer[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(05): 331-335.

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References 18

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因素		例数	1年生存率	2年生存率	3年生存率	χ²值	P值
性别						4.194	0.041
	男	92	54.0	26.7	19.0
	女	75	59.0	44.4	30.0
年龄(岁)						0.282	0.595
	≤60	63	65.9	40.4	24.9
	>60	104	50.3	30.9	24.1
症状						0.405	0.525
	有	142	68.0	47.7	26.5
	无	25	54.1	32.1	23.4
吸烟史						3.004	0.083
	有	50	53.6	21.2	12.3
	无	117	57.5	40.5	29.0
糖尿病史						0.384	0.535
	有	54	61.0	35.3	24.2
	无	113	54.2	34.4	24.0
AST(U/L)						0.151	0.697
	≤35	61	59.8	33.7	28.6
	>35	106	54.3	35.4	21.4
ALT(U/L)						0.151	0.697
	≤40	61	59.6	33.0	27.7
	>40	106	54.5	35.7	22.1
ALB(g/L)						3.902	0.048
	≥40	35	63.6	49.4	27.8
	<40	132	54.5	31.4	23.4
TBIL(μmol/L)						1.378	0.240
	≥21	110	55.7	34.6	23.0
	<21	57	57.9	34.8	27.4
CEA(μg/L)						7.706	0.006
	≤5	126	62.3	39.5	28.9
	>5	41	39.0	20.7	10.6
CA19-9(U/ml)						3.964	0.046
	≤37	32	60.5	48.5	43.1
	>37	135	55.3	31.7	20.9
术前减黄						1.729	0.189
	是	43	49.4	31.4	26.9
	否	124	58.5	35.7	23.8
肿瘤分化程度						4.846	0.028
	低	57	41.8	22.1	16.8
	中-高	110	67.5	43.4	29.2
静脉侵犯						1.385	0.239
	有	82	50	32.9	21.5
	无	85	62.4	36.9	27.1
T分期						6.712	0.035
	T1	35	75.1	57.9	37.2
	T2	99	56.2	32.0	23.7
	T3	33	37.9	19.0	12.6
淋巴结清扫数(个)						0.166	0.684
	<29	119	57.0	36.3	23.1
	≥29	48	54.5	30.0	26.7
淋巴结阳性数(个)						17.491	<0.001
	0	50	76.7	55.7	39.6
	1~2	46	61.9	44.0	31.0
	≥3	71	38.7	13.5	9.0
N分期						15.107	0.001
	N0	50	76.7	55.7	39.6
	N1	64	54.7	37.8	25.6
	N2	53	39.6	11.5	8.6
淋巴结阳性率						21.607	<0.001
	0	50	76.7	55.7	39.6
	<0.1	40	69.4	53.9	27.3
	≥0.1	77	36.9	13.6	7.8

因素		例数	1年生存率	2年生存率	3年生存率	χ²值	P值
性别						4.194	0.041
	男	92	54.0	26.7	19.0
	女	75	59.0	44.4	30.0
年龄(岁)						0.282	0.595
	≤60	63	65.9	40.4	24.9
	>60	104	50.3	30.9	24.1
症状						0.405	0.525
	有	142	68.0	47.7	26.5
	无	25	54.1	32.1	23.4
吸烟史						3.004	0.083
	有	50	53.6	21.2	12.3
	无	117	57.5	40.5	29.0
糖尿病史						0.384	0.535
	有	54	61.0	35.3	24.2
	无	113	54.2	34.4	24.0
AST(U/L)						0.151	0.697
	≤35	61	59.8	33.7	28.6
	>35	106	54.3	35.4	21.4
ALT(U/L)						0.151	0.697
	≤40	61	59.6	33.0	27.7
	>40	106	54.5	35.7	22.1
ALB(g/L)						3.902	0.048
	≥40	35	63.6	49.4	27.8
	<40	132	54.5	31.4	23.4
TBIL(μmol/L)						1.378	0.240
	≥21	110	55.7	34.6	23.0
	<21	57	57.9	34.8	27.4
CEA(μg/L)						7.706	0.006
	≤5	126	62.3	39.5	28.9
	>5	41	39.0	20.7	10.6
CA19-9(U/ml)						3.964	0.046
	≤37	32	60.5	48.5	43.1
	>37	135	55.3	31.7	20.9
术前减黄						1.729	0.189
	是	43	49.4	31.4	26.9
	否	124	58.5	35.7	23.8
肿瘤分化程度						4.846	0.028
	低	57	41.8	22.1	16.8
	中-高	110	67.5	43.4	29.2
静脉侵犯						1.385	0.239
	有	82	50	32.9	21.5
	无	85	62.4	36.9	27.1
T分期						6.712	0.035
	T1	35	75.1	57.9	37.2
	T2	99	56.2	32.0	23.7
	T3	33	37.9	19.0	12.6
淋巴结清扫数(个)						0.166	0.684
	<29	119	57.0	36.3	23.1
	≥29	48	54.5	30.0	26.7
淋巴结阳性数(个)						17.491	<0.001
	0	50	76.7	55.7	39.6
	1~2	46	61.9	44.0	31.0
	≥3	71	38.7	13.5	9.0
N分期						15.107	0.001
	N0	50	76.7	55.7	39.6
	N1	64	54.7	37.8	25.6
	N2	53	39.6	11.5	8.6
淋巴结阳性率						21.607	<0.001
	0	50	76.7	55.7	39.6
	<0.1	40	69.4	53.9	27.3
	≥0.1	77	36.9	13.6	7.8

因素	HR值	95% CI	P值
性别	1.250	0.852~1.835	0.255
术前白蛋白	0.725	0.434~1.211	0.219
术前CEA	1.361	0.889~2.083	0.157
术前CA19-9	0.936	0.553~1.584	0.806
肿瘤分化程度	1.708	1.147~2.543	0.008
T分期	1.350	0.982~1.857	0.064
N分期	0.822	0.428~1.577	0.555
淋巴结阳性数	1.612	0.825~3.151	0.162
淋巴结阳性率	2.029	1.069~3.853	0.031

因素	HR值	95% CI	P值
性别	1.250	0.852~1.835	0.255
术前白蛋白	0.725	0.434~1.211	0.219
术前CEA	1.361	0.889~2.083	0.157
术前CA19-9	0.936	0.553~1.584	0.806
肿瘤分化程度	1.708	1.147~2.543	0.008
T分期	1.350	0.982~1.857	0.064
N分期	0.822	0.428~1.577	0.555
淋巴结阳性数	1.612	0.825~3.151	0.162
淋巴结阳性率	2.029	1.069~3.853	0.031

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