Introduction
Methods
Patients
Data collection
Statistical analysis
Results
Study population
Baseline and clinicopathological characteristics
Total n = 163 | CAR < 0.2 n = 90 (55%) | CAR ≥ 0.2 n = 73 (45%) | P value | |
---|---|---|---|---|
Sex | 0.875 | |||
Male | 87 | 49 (56%) | 38 (44%) | |
Female | 76 | 41(54%) | 35 (46%) | |
Age, years (mean, SD) | 66 (± 9.7) | 65 (± 9.7) | 67 (± 9.7) | 0.591 |
ASA | 0.055 | |||
I | 12 | 7 (58%) | 5 (42%) | |
II | 121 | 73 (60%) | 48 (40%) | |
III | 29 | 10 (34%) | 19 (66%) | |
IV | 1 | 0 (0%) | 1 (100%) | |
ECOG grade | 11 unknown | 45 (59%) | 31 (41%) | 0.380 |
0 | 76 | 29 (52%) | 27 (48%) | |
1 | 56 | 7 (50%) | 7 (50%) | |
2 | 14 | 1 (20%) | 4 (80%) | |
3 | 5 | 1 (100%) | 0 (0%) | |
4 | 1 | |||
Haemoglobin, g/dL (mean, SD) | 12.9 (± 1.6) | 13.4 (± 1.5) | 12.1 (± 1.6) | < 0.001 |
CEA, ng/ml (median, IQR) | 4.1 (2.2–6.7) | 4.5 (2.2–6.6) | 3.2 (2.2–7.5) | 0.577 |
CA 19-9, U/ml (median, IQR) | 246 (60–936) | 342 (54–867) | 133 (62–1092) | 0.800 |
Supplementary nutrition | 38 unknown | |||
No | 61 | 39 (64%) | 22 (36%) | 0.398 |
Enteral | 57 | 31 (54%) | 26 (46%) | |
Parenteral | 7 | 3 (43%) | 4 (57%) | |
Neoadjuvant therapy | 0.692 | |||
No | 157 | 86 (55%) | 71 (45%) | |
Yes | 6 | 4 (67%) | 2 (33%) | |
Approach | ||||
Open or conversion | 154 | 85 (55%) | 69 (45%) | 1.000 |
Laparoscopy | 9 | 5 (56%) | 4 (44%) | |
Type of resection | ||||
PPPD | 106 | 59 (56%) | 47 (44%) | 0.043a |
PD (Whipple’s) | 24 | 9 (37%) | 15 (63%) | |
Distal pancreas resection | 22 | 17 (77%) | 5 (23%) | |
Central pancreas resection | 2 | 0 (0%) | 2 (100%) | |
Total pancreatectomy | 9 | 5 (56%) | 4 (44%) | |
Complication | ||||
Clavien–Dindo 0–2 | 137 | 76 (55%) | 61 (45%) | 1.000 |
Clavien–Dindo 3–5 | 26 | 14 (54%) | 12 (46%) | |
Tumour size in mm (median, IQR) | 30 (25–40) | 30 (25–40) | 35 (25–40) | 0.477 |
Differentiation grade | 25 unknown | |||
Well or moderate | 88 | 49 (56%) | 39 (44%) | 0.861 |
Poorly | 50 | 27 (54%) | 23 (46%) | |
Metastatic lymph nodes | ||||
< 5 | 108 | 64 (59%) | 44 (41%) | 0.183 |
≥ 5 | 55 | 26 (47%) | 29 (53%) | |
Metastatic lymph node ratio | 0.16 (0.06–0.26) | 0.13 (0.04–0.25) | 0.19 (0.01–0.29) | 0.007 |
Metastatic lymph node ratio | ||||
0 | 36 | 24 (67%) | 12 (33%) | 0.005 |
< 0.10 | 26 | 20 (77%) | 6 (23%) | |
≥ 0.10 | 101 | 46 (45%) | 55 (55%) | |
Para-aortic lymph node | ||||
No metastasis | 152 | 85 (56%) | 67 (44%) | 0.543 |
One or more metastases | 11 | 5 (45%) | 6 (55%) | |
Radicality | 2 unknown | |||
R0 | 94 | 53 (56%) | 41 (44%) | 0.726 |
R1 | 64 | 35 (55%) | 39 (45%) | |
R2 | 3 | 1 (33%) | 2 (67%) | |
Adjuvant therapy | 5 unknown | |||
No | 56 | 28 (50%) | 28 (50%) | 0.246 |
Yes | 102 | 61 (60%) | 41 (40%) |
Univariate and multivariate analyses using Cox multiple regression for overall survival
Covariate | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
HR | 95% CI | P value | HR | 95% CI | P value | |
Sex | ||||||
Female | 1 | 1 | ||||
Male | 0.632 | 0.432–0.923 | 0.018a | 1.977 | 1.191–3.282 | 0.001 |
Age (years) | 1.034 | 1.011–1.059 | 0.004a | 1.062 | 1.030 –1.094 | < 0.001 |
ASA | ||||||
I–II | 1 | |||||
III–IV | 1.374 | 0.923–2.044 | 0.117 | |||
ECOG grade | ||||||
0–1 | 1 | |||||
2–4 | 1.634 | 0.971–2.748 | 0.064a | |||
Haemoglobin | 0.961 | 0.805–1.148 | 0.661 | |||
Bilirubin | 1.000 | 0.999–1.001 | 0.833b | |||
CRP | 1.011 | 1.002–1.020 | 0.022 | |||
Albumin | 0.952 | 0.920–0.986 | 0.006 | |||
CAR | 1.406 | 1.038–1.905 | 0.028a | 1.745 | 1.200–2.539 | 0.004 |
mGPS | ||||||
0 | 1 | |||||
1 | 1.419 | 0.946–2.128 | 0.090 | |||
2 | 1.953 | 0.971–3.929 | 0.061 | |||
CEA | 1.011 | 0.999–1.022 | 0.074 | |||
CA 19.9 | 1.215 | 0.940–1.570 | 0.138 | |||
Supplementary nutrition | ||||||
No | 1 | |||||
Enteral | 1.264 | 0.838–1.905 | 0.264 | |||
Parenteral | 1.612 | 0.588–3.789 | 0.272 | |||
Neoadjuvant therapy | ||||||
No | 1 | |||||
Yes | 0.541 | 0.171–1.710 | 0.296b | |||
Approach | ||||||
Open or conversion | 1 | |||||
Laparoscopy | 0.937 | 0.380–2.306 | 0.887 | |||
Type resection | ||||||
Pancreas head | 1 | |||||
Pancreas other | 1.187 | 0.756–1.865 | 0.456 b | |||
Complication | ||||||
Clavien–Dindo 0-2 | 1 | |||||
Clavien–Dindo 3-5 | 1.266 | 0.778–2.059 | 0.342 | |||
Tumour size | 1.007 | 0.996–1.018 | 0.237 b | |||
Differentiation grade | ||||||
Well or moderate | 1 | 1 | ||||
Poorly | 1.271 | 0.837–1.931 | 0.261b | 2.812 | 1.627–4.861 | < 0.001 |
Metastatic lymph node ratio | 2.946 | 1.154–7.521 | 0.024a | |||
Para-aortic lymph node | ||||||
No metastasis | 1 | |||||
One or more metastases | 3.299 | 1.738–6.262 | < 0.001a | 4.489 | 1.883–10.702 | < 0.001 |
Radicality | ||||||
R0 | 1 | |||||
R1–R2 | 1.386 | 0.952–2.018 | 0.089a |
Determination of the cut-off point for the CAR
CAR < 0.2 | CAR ≥ 0.2 | Total | |
---|---|---|---|
Alive | 35 | 15 | 50 |
Deceased | 55 | 58 | 113 |
Total | 90 | 73 | 163 |