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

doi:10.3724/zdxbyxb-2021-0194

J Zhejiang Univ (Med Sci)

2021, Vol. 50

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

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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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

Received: 16 December 2020 Published: 16 August 2021

CLC:

R45

Corresponding Authors: WU Yulian E-mail: 3130101948@zju.edu.cn;yulianwu@zju.edu.cn

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Cite this article:

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.

URL:

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

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

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

Figure 1 Screening flowchart of the research objects in SEER database

Table 1 Univariate analyses of survival time of 5280 patients with ⅠA -ⅡB stages pancreatic dust adenocarcinoma

Table 2 Multivariate analyses of survival time of 5280 patients with ⅠA-ⅡB stages pancreatic dust adenocarcinoma

Table 3 Baseline information of pancreatic dust adenocarcinoma patients before and after propensity score matching

Table 4 Effect of chemotherapy on survival of pancreatic dust adenocarcinoma patients at different stages after propensity score matching

Figure 2 Survival curves of stage ⅠA pancreatic dust adenocarcinoma patients with different levels of tumor differentiation before and after propensity score matching (PSM)

Table 5 Effect of chemotherapy on survival of stage ⅠA pancreatic dust adenocarcinoma patients with different differentiation grades after propensity score matching


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