Table_1_Can Elderly Patients With Pancreatic Cancer Gain Survival Advantages Through More Radical Surgeries? A SEER-Based Analysis.docx

Background and AimsIn recent years, the best treatment method for pancreatic cancer in elderly patients has remained controversial. Surgery is the main treatment modality for pancreatic cancer. This study aimed to determine whether elderly patients with pancreatic cancer can gain survival advantages through more active and radical surgical treatment and evaluate the best treatment method and potential prognostic factors.
MethodsFrom the Surveillance, Epidemiology, and End Results program (SEER) database, 10,557 elderly patients (aged ≥65 years) with pancreatic cancer were included as Cohort 1, and Propensity Score Matching (PSM) evaluation was performed to generate Cohort 2 (424 pairs). Overall Survival (OS) and Cause-Specific Survival (CSS) were determined using Kaplan–Meier survival curves, and differences were assessed using the Log-rank test. Multivariate logistic regression analysis and the forest plot of hazard ratio (HR) was made to assess the association between potential prognostic factors, including surgery and different surgical methods, and survival in elderly patients.
ResultsWe identified 10,557 eligible patients with pancreatic cancer, who formed Cohort 1. The total OS and CSS in the surgery group were significantly higher than those in the non-surgery group (P < 0.001). Age, stage (AJCC 8th), grade, lymph node metastasis, radiation, chemotherapy, and surgical methods were independent factors affecting the prognosis of elderly patients. In Cohort 2, Total pancreatectomy (Total PT) had the lowest risk ratio (HR = 0.31, P < 0.001) and longest median CSS (18.000 months), while Extension Total pancreatectomy (Ex-Total PT, HR = 0.34, P < 0.001) showed the lower median CSS (17.000 months) and median OS (14.000 months). Partial pancreatectomy (Partial PT, HR = 0.46, P < 0.001) showed the lowest median CSS (13.000 months) and median OS (12.000 months), although they were still higher than the median CSS (6.000 months) and median OS (5.000 months) in the non-surgery group.
ConclusionsBased on the SEER database, surgical treatment is an independent prognostic factor in elderly patients with pancreatic cancer. Compared with other surgical methods, Total PT can offer elderly patients the best survival advantages. However, Ex-Total PT, a more radical method, does not seem to be the best treatment option for the survival and benefit of elderly patients.

研究背景与目的
近年来，老年胰腺癌患者的最优治疗方案迄今仍存在争议。手术是胰腺癌的主要治疗手段。本研究旨在明确老年胰腺癌患者能否通过更积极的根治性手术治疗获得生存获益，并评估最优治疗方案及潜在预后因素。

研究方法
本研究从监测、流行病学与最终结果 (Surveillance, Epidemiology, and End Results, SEER) 数据库中纳入10557例年龄≥65岁的老年胰腺癌患者作为队列1 (Cohort 1)，通过倾向得分匹配 (Propensity Score Matching, PSM) 法构建队列2 (Cohort 2，共424对匹配样本)。采用Kaplan-Meier生存曲线计算总生存期 (Overall Survival, OS) 和特异性生存期 (Cause-Specific Survival, CSS)，通过Log-rank检验比较组间差异。采用多因素logistic回归分析及风险比 (Hazard Ratio, HR) 森林图，评估包括手术方式及不同手术术式在内的潜在预后因素与老年胰腺癌患者生存结局的相关性。

研究结果
本研究共纳入符合入组标准的胰腺癌患者10557例，构成队列1 (Cohort 1)。手术组患者的总生存期与特异性生存期均显著高于非手术组 (P < 0.001)。年龄、AJCC第8版 (AJCC 8th) 分期、肿瘤分化程度、淋巴结转移情况、放疗、化疗及手术方式均为影响老年胰腺癌患者预后的独立因素。在队列2 (Cohort 2) 中，全胰切除术 (Total pancreatectomy, Total PT) 的风险比最低 (HR=0.31，P<0.001)，中位特异性生存期最长 (18.000个月)；而扩大全胰切除术 (Extension Total pancreatectomy, Ex-Total PT，HR=0.34，P<0.001) 的中位特异性生存期 (17.000个月) 与中位总生存期 (14.000个月) 相对较短。胰部分切除术 (Partial pancreatectomy, Partial PT) 的中位特异性生存期 (13.000个月) 与中位总生存期 (12.000个月) 最短，但其仍高于非手术组的中位特异性生存期 (6.000个月) 与中位总生存期 (5.000个月)。

研究结论
基于SEER数据库的分析结果显示，手术治疗是老年胰腺癌患者预后的独立影响因素。与其他手术术式相比，全胰切除术 (Total PT) 可为老年患者带来最优的生存获益。然而，作为更为根治性的手术方式，扩大全胰切除术 (Ex-Total PT) 似乎并非老年患者获得生存获益的最优治疗选择。