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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 Jinbo1,2(),LI Xiawei1,2,WU Yulian1,2,*()
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 wordsDuctal 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
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

变量

n

中位生存时间(月)

年龄*<65岁

1996

27.0

≥65岁

3284

21.0

性别男

2585

22.0

2695

23.0

人种白人

4297

23.0

黑人

504

21.0

黄种人

479

25.0

婚姻状态*已婚

3258

24.0

其他#

2022

21.0

保险状态无保险

5102

23.0

有保险

178

25.0

肿瘤分化程度*高分化

588

36.0

中分化

2822

25.0

低分化+未分化

1870

18.0

AJCC分期*ⅠA

591

46.0

ⅠB

1306

27.0

ⅡA

471

20.0

ⅡB

2912

20.0

化疗*

1553

14.0

3727

26.0

放疗*

3655

21.0

1625

27.0

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

变量

n

HR(95%CI

年龄*<65岁

1996

1.000

≥65岁

3284

1.229(1.136~1.328)

婚姻状态已婚

3258

1.000

其他#

2022

1.106(0.942~1.095)

肿瘤分化程度*高分化

588

1.000

中分化

2822

1.329(1.163~1.517)

低+未

1870

1.786(1.558~2.047)

AJCC分期*ⅠA

591

1.000

ⅠB

1306

1.779(1.524~2.077)

ⅡA

471

2.197(1.829~2.638)

ⅡB

2912

2.585(2.237~2.987)

化疗*

1553

1.000

3727

0.497(0.456~0.541)

放疗否

3655

1.000

1625

0.930(0.852~1.016)

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

变量

倾向评分匹配前

倾向评分匹配后

未化疗组(n=1553)

化疗组(n=3727)

未化疗组(n=1553)

化疗组(n=2185)

年龄*#<65岁

403

1593

403

827

≥65岁

1150

2134

1150

1358

肿瘤分化程度???高分化

191

397

191

263

中分化

821

2001

821

1209

低+未

541

1329

541

713

AJCC分期*ⅠA

229

362

229

283

ⅠB

403

903

403

584

ⅡA

148

323

148

190

ⅡB

773

2139

773

1128

放疗*#

1498

2157

1498

2075

55

1570

55

110

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

AJCC分期

术后化疗

n

3年存活率(%)

中位生存时间(月)

HR(95%CI

ⅠA

229

55.6

43.0

1.000

283

57.4

44.0

0.772(0.574~1.040)

ⅠB*

403

26.6

16.0

1.000

584

41.2

30.0

0.546(0.458~0.651)

ⅡA*

148

25.8

12.0

1.000

190

37.5

23.0

0.549(0.411~0.735)

ⅡB*

773

11.8

11.0

1.000

1128

27.7

21.0

0.476(0.424~0.534)

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)

肿瘤分化程度

术后化疗

n

3年存活率(%)

中位生存时间(月)#

HR(95%CI

高分化

54

74.2

42.9

??1.000

47

74.6

53.6

??0.839(0.362~1.974)

中分化

126

55.9

41.0

??1.000

168

51.7

38.0

??0.918(0.629~1.340)

低分化+未分化*

49

34.1

20.0

??1.000

68

48.5

38.0

??0.562(0.320~0.986)

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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