Abstract：
BACKGROUND: Although some clinical trials have demonstrated the benefits of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDAC), its optimal candidate has not been clarified. This study aimed to detect predictive prognostic factors for resectable PDAC patients who underwent upfront surgery and identify patient cohorts with long-term survival without neoadjuvant therapy.
METHODS: A total of 232 patients with resectable PDAC who underwent upfront surgery between January 2008 and December 2019 were evaluated.
RESULTS: The median overall survival (OS) time and 5-year OS rate of resectable PDAC with upfront surgery was 31.5 months and 33.3%, respectively. Multivariate analyses identified tumor diameter in computed tomography (CT) ≤ 19 mm [hazard ratio (HR) 0.40, p < 0.001], span-1 within the normal range (HR 0.54, p = 0.023), prognostic nutritional index (PNI) ≥ 44.31 (HR 0.51, p < 0.001), and lymphocyte-to-monocyte ratio (LMR) ≥ 3.79 (HR 0.51, p < 0.001) as prognostic factors that influence favorable prognoses after upfront surgery. According to the prognostic prediction model based on these four factors, patients with four favorable prognostic factors had a better prognosis with a 5-year OS rate of 82.4% compared to others (p < 0.001). These patients had a high R0 resection rate and a low frequency of tumor recurrence after upfront surgery.
CONCLUSIONS: We identified patients with long-term survival after upfront surgery by prognostic prediction model consisting of tumor diameter in CT, span-1, PNI, and LMR. Evaluation of anatomical, biological, nutritional, and inflammatory factors may be valuable to introduce an optimal treatment strategy for resectable PDAC.
METHODS: A total of 232 patients with resectable PDAC who underwent upfront surgery between January 2008 and December 2019 were evaluated.
RESULTS: The median overall survival (OS) time and 5-year OS rate of resectable PDAC with upfront surgery was 31.5 months and 33.3%, respectively. Multivariate analyses identified tumor diameter in computed tomography (CT) ≤ 19 mm [hazard ratio (HR) 0.40, p < 0.001], span-1 within the normal range (HR 0.54, p = 0.023), prognostic nutritional index (PNI) ≥ 44.31 (HR 0.51, p < 0.001), and lymphocyte-to-monocyte ratio (LMR) ≥ 3.79 (HR 0.51, p < 0.001) as prognostic factors that influence favorable prognoses after upfront surgery. According to the prognostic prediction model based on these four factors, patients with four favorable prognostic factors had a better prognosis with a 5-year OS rate of 82.4% compared to others (p < 0.001). These patients had a high R0 resection rate and a low frequency of tumor recurrence after upfront surgery.
CONCLUSIONS: We identified patients with long-term survival after upfront surgery by prognostic prediction model consisting of tumor diameter in CT, span-1, PNI, and LMR. Evaluation of anatomical, biological, nutritional, and inflammatory factors may be valuable to introduce an optimal treatment strategy for resectable PDAC.
摘要：
背景：尽管一些临床试验证明了新辅助治疗可切除的胰腺导管腺癌（PDAC）的益处，其最佳候选尚未明确。本研究旨在检测接受前期手术的可切除PDAC患者的预测预后因素，并确定没有新辅助治疗的长期生存患者队列。
方法：对2008年1月至2019年12月期间接受前期手术的232例可切除PDAC患者进行评估。
结果：可切除PDAC前期手术的中位总生存期（OS）时间和5年OS率分别为31.5个月和33.3％，分别。多变量分析确定计算机断层扫描（CT）中的肿瘤直径≤19mm[风险比（HR）0.40，p<0.001]，span-1在正常范围内(HR0.54，p=0.023)，预后营养指数（PNI）≥44.31（HR0.51，p<0.001），和淋巴细胞与单核细胞比率（LMR）≥3.79（HR0.51，p<0.001）是影响前期手术后良好预后的预后因素。根据基于这四个因素的预后预测模型，具有4种有利预后因素的患者预后较好,5年OS率为82.4%(p<0.001).这些患者在前期手术后R0切除率高，肿瘤复发频率低。
结论：我们通过由CT肿瘤直径组成的预后预测模型来确定前期手术后长期生存的患者，span-1,PNI,还有LMR.解剖学评估，生物，营养,和炎症因子可能是有价值的为可切除的PDAC引入最佳治疗策略。
方法：对2008年1月至2019年12月期间接受前期手术的232例可切除PDAC患者进行评估。
结果：可切除PDAC前期手术的中位总生存期（OS）时间和5年OS率分别为31.5个月和33.3％，分别。多变量分析确定计算机断层扫描（CT）中的肿瘤直径≤19mm[风险比（HR）0.40，p<0.001]，span-1在正常范围内(HR0.54，p=0.023)，预后营养指数（PNI）≥44.31（HR0.51，p<0.001），和淋巴细胞与单核细胞比率（LMR）≥3.79（HR0.51，p<0.001）是影响前期手术后良好预后的预后因素。根据基于这四个因素的预后预测模型，具有4种有利预后因素的患者预后较好,5年OS率为82.4%(p<0.001).这些患者在前期手术后R0切除率高，肿瘤复发频率低。
结论：我们通过由CT肿瘤直径组成的预后预测模型来确定前期手术后长期生存的患者，span-1,PNI,还有LMR.解剖学评估，生物，营养,和炎症因子可能是有价值的为可切除的PDAC引入最佳治疗策略。
