接受术前化疗的胰腺导管腺癌复发和生存预测模型：单中心回顾性研究

Journal of Pancreatology Pub Date : 2024-01-23 DOI:10.1097/jp9.0000000000000171

Yixin Zhang, Xin Han, Zhongquan Sun, Wanlu You, Haoze Cao, Xiaochang Wu, Weilin Wang, Yuan Ding

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引用次数: 0

摘要

将术前化疗视为一种整体序贯治疗模式，识别与胰腺导管腺癌（PDAC）复发和生存相关的预测因素，并构建模型为候选患者提供决策支持和治疗选择。回顾2016年1月至2023年6月在浙江大学医学院附属第二医院接受术前化疗的PDAC患者。对无复发生存期（RFS）和总生存期（OS）的相关因素进行单变量和多变量分析。根据所有重要预测因素的危险比（HR）建立评分系统。卡普兰-梅耶尔分析和对数秩检验用于计算RFS和OS。共对 72 例接受术前化疗的 PDAC 患者进行了分析。术前化疗后，21（29.17%）例患者实现了任何放射学降期，68（94.44%）例患者实现了切除边缘阴性（R0边缘）。对于不分泌碳水化合物抗原 19-9（CA19-9）的患者，肿瘤长度直径的缩小率≥20%（P=0.027）和切除边缘状态（P=0.011）是预测患者生存期的独立指标。而对于分泌CA19-9的患者，化疗结束时CA19-9血清水平≥1000（P=0.027）和切除边缘状态（P=0.012）是OS的独立预测因素。在提议的评分系统中，根据HR分别对这些因素进行评分。根据评分系统分组的患者的复发曲线和生存曲线在统计学上也有显著差异。对于不分泌CA19-9的患者，评分为2至2.97的患者的生存期明显短于评分为4.94至5.91的患者（P=0.009）。而对于分泌CA19-9的患者，评分为2的患者的OS明显短于评分为3.75至4.99的患者（P<0.001）。结合CA19-9血清水平或肿瘤缩小率以及术后病理结果的RFS和OS简单评分模型可帮助临床医生评估接受术前化疗的PDAC患者的预后。

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Recurrence and Survival Prediction Models for Receiving Preoperative Chemotherapy Pancreatic Ductal Adenocarcinoma Cancer: A Single-center Retrospective Research

Regard preoperative chemotherapy as a holistic sequential treatment modality to identify predictive factors associated with recurrence and survival in pancreatic ductal adenocarcinoma (PDAC) and construct models to provide decision support and treatment selection for the candidate patients. Retrospect PDAC patients who received preoperative chemotherapy from January 2016 to June 2023 at the Second Affiliated Hospital of Zhejiang University School of Medicine. Run a univariate and multivariate analysis of factors associated with recurrence-free survival (RFS) and overall survival (OS). Scoring systems were developed based on the hazard ratios (HR) of all significant predictors. Kaplan–Meier analyses and log-rank tests were used to calculate RFS and OS. A total of 72 PDAC patients with preoperative chemotherapy were analyzed. After preoperative chemotherapy, 21(29.17%) patients achieved any radiologic downstaging with 68(94.44%) patients achieving negative resection margin status (R0 margins). For carbohydrate antigen 19-9(CA19-9) non-secreting patients, shrinkage rate of length diameter of tumor≥20%(P=0.027), resection margin status(P=0.011) were independent predictors of OS. And for CA19-9 secreting patients, CA19-9 serum level at the end of chemotherapy≥1000(P=0.027) and resection margin status (P=0.012) were independent predictors of OS. Points according HR were allocated to these factors in the proposed scoring system, respectively. Recurrence curves and survival curves with statistically significant differences were also presented for patients grouped according to the scoring systems. For CA19-9 non-secreting patients, the OS of patients with a score from 2 to 2.97 was significantly shorter than that of patients with a score from 4.94 to 5.91 (P=0.009). And for CA19-9 secreting patients, the OS of patients with a score of 2 was significantly shorter than that of patients with a score from 3.75 to 4.99 (P<0.001). Simple scoring models for RFS and OS incorporating CA19-9 serum levels or the tumor shrinkage rate and postoperative pathology may assist clinicians in evaluating prognosis of PDAC patients with preoperative chemotherapy.

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Journal of Pancreatology

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