Preoperative prognostic factors in patients with ductal adenocarcinoma of the head of the pancreas

ABSTRACT Objective: To identify the preoperative prognostic factors influencing pancreatic cancer survival following curative resection in a single Brazilian institution. Methods: From 2005 to 2018, preoperative clinic, demographic and laboratory data were prospectively collected. Survival analysis was performed by the Kaplan-Meier method and the comparison between curves by the log-rank test. For multivariate analysis, the Cox regression model was used. Results: advanced age (p = 0.012) and previous history of cancer (p = 0.026) were the preoperative factors, according to the univariate analysis, that significantly impacted survival. Patients with preoperative serum levels of CA 19.9 from 38 to 554 U/mL had a 3.15 times higher chances of death (HR 3.15; 95% CI 1.01-9.82; p = 0.047), whereas patients with the marker above 554 U/mL were 3.96 times more likely than those with the normal level (HR 3.96; 95% CI 1.19-13.10; p = 0.024), by using the multivariate analysis. Patients with previous comorbidities had a 2.90 times higher chance of death than those without associated conditions (HR 2.90; 95% CI 1.10-7.67; p = 0.032). Conclusion: Preoperative factors related to the worst prognosis after pancreatic ductal adenocarcinoma resection were advanced age, presence of comorbidities, previous history of cancer and elevated preoperative serum CA 19.9.

摘要
研究目的：旨在明确巴西单中心内，接受根治性切除术后的胰腺癌（pancreatic cancer）患者生存相关的术前预后影响因素。
研究方法：2005年至2018年间，前瞻性收集术前临床资料、人口统计学资料及实验室检测数据。采用Kaplan-Meier法开展生存分析，通过log-rank检验对各组生存曲线进行组间比较；多因素分析则采用Cox回归模型。
研究结果：单因素分析显示，高龄（p=0.012）及既往癌症病史（p=0.026）为对患者生存产生显著影响的术前因素。多因素分析结果表明，术前血清CA 19.9水平介于38~554 U/mL区间的患者，死亡风险较正常水平者升高3.15倍（风险比HR=3.15；95%置信区间CI：1.01~9.82；p=0.047）；而血清CA 19.9水平高于554 U/mL的患者，其死亡风险为正常水平者的3.96倍（HR=3.96；95%CI：1.19~13.10；p=0.024）。合并基础疾病的患者，死亡风险较无基础疾病者升高2.90倍（HR=2.90；95%CI：1.10~7.67；p=0.032）。
研究结论：与胰腺导管腺癌（pancreatic ductal adenocarcinoma）根治性切除术后不良预后相关的术前因素包括高龄、合并基础疾病、既往癌症病史及术前血清CA 19.9水平升高。