| Objective To analyze the correlation between the clinical,pathological,laboratory parameters and the survival prognosis of patients undergoing radical resection of pancreatic cancer,and to explore the risk factors affecting the prognosis of pancreatic cancer after surgery.Methods A total of 118 patients who received radical surgery for pancreatic cancer in hepatobiliary surgery department of Tangshan people’s hospital,Tangshan workers’ hospital and Tangshan Kailuan hospital from January 1,2010 to December 31,2017 were selected as subjects.The clinical data,preoperative and postoperative testing parameters including carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA),neutrophil-to-lymphocyte ratio(NLR)and carbohydrate antigen 125(CA125)were collected.The data were analyzed by univariate analysis(Kaplan-Meier log-rank test)and multivariate analysis(Cox proportional risk regression model)to explore the factors affecting postoperative survival and prognosis of pancreatic cancer patients.Results 1 Among the 118 patients,23 were deleted.The average survival time was 231.75±151.75 days,and the median survival time was 236 days.2 Univariate analysis showed that age,tumor diameter,postoperative chemotherapy,postoperative complications,peripancreatic invasion,vascular invasion,degree of differentiation,clinical staging,preoperative CA199,preoperative CEA,preoperative TBIL,preoperative NLR,and postoperative CA125 had significant differences on the prognosis of pancreatic cancer patients(all P<0.05).The median survival time of 55 patients aged>60 years old was 187 days,which was significantly shorter than the median survival time of 330 days of 63 patients aged≤60 years old(P=0.001).The median survival time of 62 patients with tumor diameter>4 cm was 187 days,which was significantly shorter than that of 280 days of 56 patients with tumor diameter≤4 cm(P=0.000).The median survival time of the 37 patients with peripancreatic invasion was 206 days,which was shorter than that of 293 days of the 81 patients without peripancreatic invasion(P=0.036).The median survival time of 46 patients with vascular invasion was 178 days,which was also significantly shorter than that of 263 days of 72 patients without vascular invasion(P=0.013).The median survival time of 39 patients with high differentiation was 275 days,66 patients with medium differentiation was 257 days,13 patients with low differentiation was 52 days.With the decrease of differentiation,the prognosis and survival time of the patients were significantly reduced(P=0.000).The median survival time of 2 IA patients was 445 days,20 IB patients was 400 days,35 IIA patients was 248 days,32 IIB patients was 259 days,29 III patients was 155 days.With the progression of tumor stage,the prognosis decreased significantly(P=0.000).The median survival time of 29 patients with postoperative chemotherapy was 201 days,which was better than that of 132 days of 89 patients without postoperative chemotherapy(P=0.004).The median survival time of 78 patients without postoperative complications was 264 days,which was better than 189 days for 40 patients with postoperative complications(P=0.017).The median survival time of 47 patients with preoperative CA19-9≤37 U/L was 279 days,40 patients with preoperative CA19-9 between 37 U/L and 180 U/L was 238 days,and 31 patients with preoperative CA19-9>180 U/L was 212 days.In accompany with enhanced preoperative CA19-9 level,the prognosis and survival time of patients decreased significantly(P=0.026).The median survival time of 88 patients with preoperative CEA≤5ng/ml was 268 days,which was better than 189 days of 30 patients with preoperative CEA>5 ng/ml(P=0.000).The median survival time of 79 patients with preoperative NLR≤2.8 was 266 days,which was better than 39 patients with preoperative NLR>2.8 patients with a median survival time of 166 days(P=0.000).The median survival time of 76 patients with total bilirubin(TBIL)≤34.2 μmol/L was 264 days,which was better than 206 days of 42 patients with total bilirubin>34.2 μmol/L(P=0.015).The median survival time of 111 patients with postoperative CA125≤35 U/ml was 156 days,which was better than 120 days of 7 patients with postoperative CA125>35 U/ml(P=0.038).3 The results of multivariate analysis showed that preoperative CA19-9,peripancreatic invasion,vascular invasion and degree of differentiation could be independent factors affecting the survival and prognosis of patients undergoing radical resection of pancreatic cancer(all P <0.05).4 Stratified analysis showed that among the patients with increased preoperative CA19-9,TBIL and NLR,the median survival time of 37 patients with postoperative CA19-9≤37 U/L was 279 days,which was better than 206 days of 34 patients with postoperative CA19-9>37 U/L(P=0.009).The median survival time of 18 patients with postoperative TBIL≤34.2 μmol/L was 323 days,which was better than 195 days of 24 patients with postoperative TBIL>34.2 μmol/L(P=0.001).The median survival time of 21 patients with postoperative NLR>2.8 was 222 days,which was better than 99 days of 18 patients with postoperative NLR≤2.8(P=0.031).Conclusions 1 Age,tumor diameter,postoperative chemotherapy,postoperative complications,peripancreatic invasion,vascular invasion,degree of differentiation,clinical staging,preoperative CA19-9,preoperative CEA,preoperative TBIL,preoperative NLR,and postoperative CA125 could affect the prognosis of pancreatic cancer patients.High preoperative CA19-9,peripancreatic invasion,vascular invasion and low degree of differentiation were independent factors affecting the survival and prognosis of patients after radical resection of pancreatic cancer.2 The changes of tumor markers and test indexes before and after surgery could provide a reference for predicting and evaluating the survival and prognosis of patients.Figure16;Table3;Reference 85. |
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