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.
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。