基于<strong>SEER</strong>数据库分析早期胰腺导管腺癌患者能否从常用术后化疗方案中获益

doi:10.3724/zdxbyxb-2021-0194

浙江大学学报（医学版）

2021, Vol. 50

Issue (3): 375-382 DOI: 10.3724/zdxbyxb-2021-0194

原著

基于SEER数据库分析早期胰腺导管腺癌患者能否从常用术后化疗方案中获益

施锦波^1,²(

),励夏炜^1,²,吴育连^1,^2,*(

)

1.浙江大学医学院附属第二医院外科，浙江杭州 310009
2.浙江大学癌症研究院，浙江杭州 310058

Whether early stage pancreatic ductal adenocarcinoma patients could benefit from the post-operation chemotherapy regimens: a SEER-based propensity score matching study

SHI Jinbo^1,²(

),LI Xiawei^1,²,WU Yulian^1,^2,*(

)

1. Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
2. Cancer Center, Zhejiang University, Hangzhou 310058, China

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摘要：

目的：探究术后辅助化疗能否改善早期胰腺导管腺癌（PDAC）患者的生存预后。方法：从监测、流行病学和结果（SEER）数据库中采集2010至2015年诊断为ⅠA~ⅡB期PDAC且接受过手术治疗的5280例患者的资料，通过倾向评分匹配（PSM）减小组间偏倚，用Kaplan-Meier法进行单因素分析及生存分析，采用Cox比例风险模型进行多因素分析。结果：5280例患者的生存分析及多因素分析结果显示，年龄、肿瘤分化、分期、是否化疗是影响PDAC患者预后的独立危险因素。用PSM法减小研究偏倚后共得到ⅠA~ⅡB期病例3738例，进一步行生存分析及多因素分析，提示化疗能够延长ⅠB、ⅡA、ⅡB期患者的术后中位生存时间，而不能改善ⅠA期患者的生存预后。其中ⅠA期共512例，接受化疗者与未化疗者3年存活率和中位生存时间差异均无统计学意义（分别为57.4%和44.0个月与55.6%和43.0个月，均P>0.05）；高分化组和中分化组接受化疗者与未化疗者3年存活率和中位生存时间差异均无统计学意义（均P>0.05），而低分化+未分化组接受化疗者3年存活率和术后中位生存时间均高于未化疗者（分别为48.5%和38.0个月与34.1%和20.0个月，均P<0.05）。结论：高、中分化的ⅠA期PDAC患者不能从当前常用的术后化疗方案中获益，但术后化疗是低分化+未分化ⅠA期PDAC患者预后的独立影响因素。

关键词： 胰腺导管腺癌; SEER数据库; 化学药物治疗; 疾病分期; 肿瘤分化; 预后; 生存分析

Abstract:

Objective:To investigate whether chemotherapy could prolong the postoperative survival time in patients with early stages pancreatic ductal adenocarcinoma (PDAC). Methods:A total of 5280 stage ⅠA -ⅡB PDAC patients diagnosed from 2010 to 2015 were selected from surveillance，epidemiology，and end results (SEER) database. Propensity score matching (PSM) analysis was adopted to reduce the baseline differences between the groups. Univariate survival analysis was conducted with the Kaplan-Meier method. Multivariate survival analysis was performed with the Cox proportional hazards model. Results:Univariate and multivariate survival analyses showed that age, differentiation, stage, chemotherapy were independent risk factors for the survival of PDAC patients. After PSM, it is found that adjuvant chemotherapy could prolong the median overall survival time (mOS) for stage ⅠB, ⅡA and ⅡB patients. However, for stage ⅠA patients, there were no significant differences in 3-year survival rate and mOS between patients with chemotherapy (n=283) and without chemotherapy (n=229) (57.4% vs 55.6%, 44.0?months vs 43.0?months, all P>0.05). Further analyses show that among 101 patients with well differentiated PDAC and 294 patients with moderately differentiated PDAC, there were no significant differences in 3-year survival rate and mOS between patients with and without chemotherapy (allP>0.05). Among 117 patients with low-differentiated + undifferentiated PDAC, 3-year survival rate and mOS in patients with chemotherapy were significantly better than those without chemotherapy (48.5% vs 34.1%, 38.0?months vs 20.0?months, allP<0.05).Conclusion:Chemotherapy regimen used currently is not beneficial for patients with moderately and well differentiated stage ⅠA PDAC, but it is an independent prognostic factor for low-differentiated + undifferentiated PDAC patients.

Key words: Ductal adenocarcinoma of the pancreas SEER database Chemotherapy Staging Differentiation Prognosis Survival analysis

收稿日期: 2020-12-16 出版日期: 2021-08-16

CLC:

R45

基金资助: 国家自然科学基金（81772562）

通讯作者: 吴育连 E-mail: 3130101948@zju.edu.cn;yulianwu@zju.edu.cn

作者简介: 施锦波，住院医师，主要从事胰腺癌早期诊断研究；E-mail：3130101948@zju.edu.cn；https：//orcid.org/0000-0002-8311-303X

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引用本文:

施锦波,励夏炜,吴育连. 基于SEER数据库分析早期胰腺导管腺癌患者能否从常用术后化疗方案中获益[J]. 浙江大学学报（医学版）, 2021, 50(3): 375-382.

SHI Jinbo,LI Xiawei,WU Yulian. Whether early stage pancreatic ductal adenocarcinoma patients could benefit from the post-operation chemotherapy regimens: a SEER-based propensity score matching study. J Zhejiang Univ (Med Sci), 2021, 50(3): 375-382.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0194 或 http://www.zjujournals.com/med/CN/Y2021/V50/I3/375

图 1 SEER数据库中病例资料筛选流程图SEER：监测、流行病学和结果；PDAC：胰腺导管腺癌；AJCC：美国癌症联合委员会.

表 1 影响5280例ⅠA~ⅡB期胰腺导管腺癌患者生存时间的单因素分析结果

表 2 影响5280例ⅠA~ⅡB期胰腺导管腺癌患者生存时间的多因素分析结果

表 3 胰腺导管腺癌患者倾向评分匹配结果

表 4 倾向评分匹配后不同AJCC分期胰腺导管腺癌患者术后化疗对生存预后的影响

图 2 倾向评分匹配（PSM）前后ⅠA期不同肿瘤分化程度胰腺导管腺癌患者的生存曲线

表 5 倾向评分匹配后不同分化程度的ⅠA期胰腺导管腺癌患者术后化疗对生存预后的影响

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