Introduction
Data and methods
Data sources and patient selection
Surgery and adjuvant chemotherapy
Follow-up and evaluation
Propensity score matching and statistical analysis
Results
Clinical characteristics of patients
Variables | Total cohort | X2/Z | P | Propensity score-matched cohort | X2/Z | P | ||
---|---|---|---|---|---|---|---|---|
no-AC (n = 49) | AC (n = 119) | no-AC (n = 48) | AC (n = 48) | |||||
Gender | ||||||||
Male | 24 | 70 | 24 | 27 | ||||
Female | 25 | 49 | 1.365 | 0.243 | 24 | 21 | 0.376 | 0.539 |
Age(years) | ||||||||
< = 55 | 13 | 41 | 12 | 17 | ||||
> 55 | 36 | 78 | 0.999 | 0.318 | 36 | 31 | 1.235 | 0.266 |
Pathological diagnosis | ||||||||
Ductal adenocarcinoma | 30 | 93 | 29 | 34 | ||||
Acinar cell carcinoma | 5 | 7 | 5 | 2 | ||||
Other | 14 | 19 | 5.073 | 0.079 | 14 | 12 | 1.836 | 0.399 |
Tumor differentiation | ||||||||
Low | 14 | 56 | 13 | 22 | ||||
Moderate | 28 | 49 | 28 | 21 | ||||
High | 7 | 14 | 4.954 | 0.084 | 7 | 5 | 3.648 | 0.161 |
Tumor size(cm) | ||||||||
< = 5 cm | 29 | 81 | 29 | 34 | ||||
> 5 cm | 19 | 38 | 0.890 | 0.345 | 19 | 14 | 1.154 | 0.283 |
Microvascular invasion | ||||||||
Absence | 32 | 85 | 32 | 33 | ||||
Presence | 17 | 34 | 0.615 | 0.433 | 16 | 15 | 0.068 | 0.827 |
Nerve invasion | ||||||||
Absence | 18 | 22 | 18 | 6 | ||||
Presence | 31 | 97 | 6.371 | 0.012 | 30 | 42 | 4.000 | 0.105 |
Preoperative Ca19-9(u/ml) | ||||||||
≤ 37.00 | 18 | 32 | 18 | 11 | ||||
> 37.00 | 31 | 87 | 1.609 | 0.205 | 30 | 37 | 2.421 | 0.120 |
Preoperative CEA(ng/mL) | ||||||||
≤ 5.00 | 39 | 65 | 38 | 23 | ||||
> 5.00 | 10 | 54 | 9.176 | 0.002 | 10 | 25 | 3.117 | 0.101 |
Preoperative TBIL(umol/L) | ||||||||
≤ 17.10 | 35 | 96 | 35 | 37 | ||||
> 17.10 | 14 | 23 | 1.727 | 0.189 | 13 | 11 | 0.222 | 0.637 |
Tumor location | ||||||||
Head and neck of pancreas | 12 | 26 | 11 | 6 | ||||
Body and tail of pancreas | 37 | 93 | 0.138 | 0.710 | 37 | 42 | 1.787 | 0.181 |
AJCC 8th Stage | ||||||||
I | 21 | 18 | 21 | 14 | ||||
II | 15 | 73 | 14 | 24 | ||||
III | 13 | 28 | 9.345 | 0.005 | 13 | 10 | 4.423 | 0.110 |
Lymphatic metastasis | ||||||||
Absence | 37 | 68 | 36 | 25 | ||||
Presence | 12 | 51 | 4.996 | 0.025 | 12 | 23 | 3.441 | 0.160 |
Surgical type | ||||||||
Open surgery | 33 | 78 | 32 | 28 | ||||
Laparoscopic surgery | 7 | 25 | 7 | 13 | ||||
Da Vinci Surgical System | 9 | 16 | 1.406 | 0.495 | 9 | 7 | 2.317 | 0.314 |
Revascularization | ||||||||
Absence | 37 | 104 | 36 | 42 | ||||
Presence | 12 | 15 | 3.635 | 0.057 | 12 | 6 | 2.462 | 0.117 |
Operation time (min) | ||||||||
≤ 180 | 12 | 17 | 12 | 7 | ||||
> 180 | 37 | 102 | 2.530 | 0.112 | 36 | 41 | 1.640 | 0.200 |
Amount of bleeding(mL) | ||||||||
≤ 400 | 33 | 82 | 33 | 32 | ||||
> 400 | 16 | 37 | 0.039 | 0.843 | 15 | 16 | 0.048 | 0.827 |
Perioperative blood transfusion | ||||||||
Absence | 29 | 88 | 29 | 32 | ||||
Presence | 20 | 31 | 3.579 | 0.058 | 19 | 16 | 0.405 | 0.525 |
Surgical margin | ||||||||
R0 | 42 | 95 | 41 | 41 | ||||
R1/R2 | 7 | 24 | 0.798 | 0.372 | 7 | 7 | 0.000 | 1.000 |
Postoperative pancreatic fistula | ||||||||
Absence | 37 | 88 | 36 | 34 | ||||
Presence | 12 | 31 | 0.044 | 0.833 | 12 | 14 | 0.211 | 0.646 |
Postoperative hospitalization time(days) | ||||||||
≤ 14 | 39 | 83 | 38 | 33 | ||||
> 14 | 10 | 36 | 1.692 | 0.193 | 10 | 15 | 1.352 | 0.245 |
Survival analysis in the AC and no-AC groups
Prognostic factors for RFS and OS analyzed via Cox regression
Characteristics | RFS | OS | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate analyses | Multivariate analyses | Univariate analyses | Multivariate analyses | ||||||||||
HR | 95%CI | P value | HR | 95%CI | P value | HR | 95%CI | P value | HR | 95%CI | P value | ||
Gender | (Male vs female) | 0.95 | 0.55–1.66 | 0.869 | 0.62 | 0.33–1.18 | 0.143 | ||||||
Age(years) | (< = 55 vs > 55) | 1.47 | 0.76–2.84 | 0.253 | 2.39 | 1.20–4.75 | 0.013 | 2.33 | 1.17–4.64 | 0.016 | |||
Pathological diagnosis | Ductal adenocarcinoma | Ref. | Ref. | ||||||||||
Acinar cell carcinoma | 0.64 | 0.21–1.90 | 0.420 | 1.07 | 0.40–2.80 | 0.890 | 1.25 | 0.46–3.40 | 0.654 | ||||
Other | 0.92 | 0.49–1.73 | 0.810 | 0.32 | 0.14–0.72 | 0.006 | 0.33 | 0.14–0.77 | 0.010 | ||||
Tumor differentiation | Low | Ref. | Ref. | ||||||||||
Moderate | 0.77 | 0.43–1.39 | 0.402 | 0.75 | 0.40–1.41 | 0.380 | |||||||
High | 1.04 | 0.41–2.60 | 0.932 | 0.53 | 0.15–1.81 | 0.313 | |||||||
Tumor size(cm) | (< = 5.00 vs > 5.00) | 0.89 | 0.49–1.61 | 0.706 | 0.58 | 0.29–1.18 | 0.132 | ||||||
Microvascular invasion | (Absence vs presence) | 0.98 | 0.54–1.77 | 0.951 | 0.65 | 0.35–1.21 | 0.176 | ||||||
Nerve invasion | (Absence vs presence) | 1.14 | 0.57–2.28 | 0.719 | 1.08 | 0.50–2.34 | 0.852 | ||||||
Preoperative Ca19-9(u/ml) | (≤ 37.00 vs > 37.00) | 1.55 | 0.79–3.04 | 0.201 | 1.61 | 0.77–3.35 | 0.205 | ||||||
Preoperative CEA(ng/mL) | (≤ 5.00 vs > 5.00) | 1.34 | 0.77–2.33 | 0.294 | 1.24 | 0.70–2.20 | 0.465 | ||||||
Preoperative TBIL(umol/L) | (≤ 17.10 vs > 17.10) | 1.78 | 0.99–3.18 | 0.053 | 1.32 | 0.72–2.43 | 0.373 | ||||||
Tumor location | (Head and neck of pancreas vs Body and tail of pancreas) | 1.65 | 0.70–3.87 | 0.252 | 0.80 | 0.38–1.67 | 0.547 | ||||||
AJCC 8th stage | I(T1N0M0, T2N0M0) | Ref. | Ref. | ||||||||||
II(T3N0M0, T1~3N1M0) | 1.21 | 0.63–2.32 | 0.549 | 1.20 | 0.63–2.30 | 0.566 | 0.87 | 0.44–1.70 | 0.690 | ||||
III(T4N0~2M0, T1~4N2M0) | 2.11 | 1.01–4.40 | 0.046 | 1.83 | 0.87–3.86 | 0.110 | 1.36 | 0.66–2.78 | 0.394 | ||||
Lymphatic metastasis | (Absence vs presence) | 2.28 | 1.28–4.06 | 0.005 | 2.75 | 1.52–4.95 | 0.001 | 1.97 | 1.04–3.74 | 0.037 | 1.90 | 1.01–3.59 | 0.047 |
Surgical type | Open surgery | Ref | Ref | ||||||||||
Laparoscopic surgery | 2.27 | 1.21–4.25 | 0.010 | 2.17 | 1.16–4.06 | 0.015 | 2.19 | 1.05–4.58 | 0.036 | 2.11 | 1.00–4.48 | 0.050 | |
da Vinci Surgical system | 0.59 | 0.23–1.52 | 0.278 | 0.63 | 0.24–1.65 | 0.355 | 0.98 | 0.40–2.39 | 0.980 | 1.16 | 0.47–2.86 | 0.746 | |
Revascularization | (Absence vs presence) | 1.18 | 0.61–2.30 | 0.625 | 1.47 | 0.73–2.99 | 0.282 | ||||||
Operation time(min) | (≤ 180 vs > 180) | 1.67 | 0.78–3.58 | 0.186 | 1.20 | 0.60–2.37 | 0.609 | ||||||
Amount of bleeding(mL) | (≤ 400 vs > 400) | 2.11 | 1.20–3.71 | 0.009 | 2.12 | 1.19–3.79 | 0.011 | 1.31 | 0.71–2.40 | 0.389 | |||
Perioperative blood transfusion | (Absence vs presence) | 1.61 | 0.93–2.78 | 0.090 | 1.01 | 0.56–1.80 | 0.979 | ||||||
Surgical margin | (R0 vs R1/R2) | 2.42 | 1.21–4.87 | 0.013 | 2.42 | 1.17–5.01 | 0.017 | 1.55 | 0.77–3.15 | 0.222 | |||
Postoperative pancreatic fistula | (Absence vs presence) | 1.03 | 0.55–1.93 | 0.938 | 1.70 | 0.91–3.19 | 0.095 | ||||||
Hospitalization time (days) | (≤ 14 vs > 14) | 1.17 | 0.63–2.17 | 0.610 | 0.67 | 0.34–1.33 | 0.259 |
Survival analysis of patients with pancreatic cancer of different AJCC 8th edition stages
Survival analysis of patients with lymphatic metastasis
Analysis of adverse events in patients who received adjuvant chemotherapy
Adverse Event | CTCAE v5.0 grade 1–2 | CTCAE v5.0 grade 3–4 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
GP (n = 39) | mFOLFIRINOX (n = 29) | S−1 (n = 51) | Z | P | GP (n = 39) | mFOLFIRINOX (n = 29) | S−1 (n = 51) | Z | P | |
Nausea | 19 48.7% | 15 51.7% | 24 47.1% | 0.161 | 0.923 | 10 25.6% | 5 17.2% | 8 15.7% | 1.512 | 0.470 |
Diarrhea | 17 43.6% | 13 44.8% | 25 49.0% | 0.292 | 0.864 | 5 12.8% | 3 10.3% | 5 9.8% | 0.220 | 0.896 |
Rash | 18 46.2% | 8 27.6% | 22 43.1% | 2.674 | 0.263 | 2 5.1% | 3 10.3% | 3 5.9% | 0.822 | 0.663 |
Hand-foot syndrome | 12 30.8% | 8 27.6% | 22 43.1% | 2.478 | 0.290 | 5 12.8% | 4 13.8% | 4 7.8% | 0.887 | 0.642 |
Fatigue | 13 33.3% | 11 37.9% | 21 41.2% | 0.578 | 0.749 | 5 12.8% | 5 17.2% | 4 7.8% | 1.635 | 0.441 |
Leucopenia | 13 33.3% | 13 44.8% | 20 39.2% | 0.938 | 0.625 | 4 10.3% | 4 13.8% | 7 13.7% | 0.291 | 0.865 |
Anemia | 9 23.1% | 10 34.5% | 9 17.6% | 2.919 | 0.232 | 7 17.9% | 4 13.8% | 6 11.8% | 0.698 | 0.705 |
Thrombocytopenia | 14 35.9% | 9 31.0% | 11 21.6% | 2.337 | 0.311 | 2 5.1% | 1 3.4% | 3 5.9% | 0.230 | 0.892 |
ALT elevation | 7 17.9% | 12 41.4% | 7 13.7% | 8.797 | 0.012 | 4 10.3% | 4 13.8% | 5 9.8% | 0.329 | 0.848 |
AST elevation | 6 15.4% | 12 41.4% | 8 15.7% | 8.567 | 0.014 | 3 7.7% | 0 0.0% | 5 9.8% | 2.921 | 0.232 |
TBIL elevation | 7 17.9% | 14 48.3% | 14 27.5% | 7.534 | 0.023 | 4 10.3% | 0 0.0% | 2 3.9% | 3.888 | 0.143 |
Proteinuria | 10 25.6% | 12 41.4% | 13 25.5% | 2.645 | 0.266 | 0 0.0% | 2 6.9% | 2 3.9% | 2.522 | 0.283 |
Hematuresis | 5 12.8% | 11 37.9% | 9 17.6% | 6.927 | 0.031 | 3 7.7% | 0 0.0% | 1 2.0% | 3.569 | 0.168 |
Creatinine elevation | 7 17.9% | 12 41.4% | 10 19.6% | 6.052 | 0.049 | 4 10.3% | 1 3.4% | 2 3.9% | 2.012 | 0.366 |