| Background:Pancreatic cancer(PC)has a poor prognosis in the world at pres ent.Although some pancreatic cancer patients have the opportunity to undergo su rgery,as an invasive cancer,the probability of postoperative recurrence is very h igh.For most patients with pancreaticcancer after surgery,adjuvant chemotherapy can delay tumor recurrence.Gemcitabine combined regimen has been widely used in clinical practice,but how to choose the best chemotherapy regimen is an ard uous task for clinicians.Gemcitabine plus nab-paclitaxel(GA)has a good clinica l adaptability in the treatment of advanced pancreatic cancer.However,as an adj uvant chemotherapy regimen after resection of resectable pancreatic cancer,there have been few reports in domestic clinical practice.Objective:In this study,we screened out the significant factors affecting postoperative disease-free survival(DFS)of pancreatic cancer and investigated the effect of GA as adjuvant chemotherapy of pancreatic cancer in delaying tumor recurrence with DFS as the primary endpoint.The effects of chemotherapy or no chemotherapy on DFS were compared in each stage of pancreatic cancer.Methods:Postoperative pancreatic cancer patients were recruited from the Second Affiliated Hospital of Dalian Medical University,and the time was set from January 1,2014 to December 31,2018.The age,sex,blood glucose,tumor location,tumor diameter,vascular invasion,lymph node metastasis,histological type,postoperative CA199 and CEA of the patients were collected,and the pancreatic cancer was classified according to AJCC eighth edition.We screened out the independent risk factors of DFS in patients with pancreatic cancer by using Cox proportional hazards model.After univariate analysis,the meaningless factors were eliminated and the other factors were included in multivariate analysis.According to whether the patients received adjuvant chemotherapy,they were divided into two different groups.The chemotherapy group was treated with gemcitabine(1000mg/m~2)+nab-paclitaxel(125mg/m~2)as postoperative adjuvant chemotherapy.The first chemotherapy time was within 60 days after operation,with a cycle of 21 days,scheduled for 4-6 cycles.The effect of GA as adjuvant chemotherapy on median disease-free survival(DFS)of pancreatic cancer was analyzed by drawing survival curve,and we compared the differences between each stages of pancreatic cancer with or without chemotherapy.Results:Among 93 pancreatic cancer patients after surgery,6 patients losted contact.45patients in the GA group,8 patients did not complete the scheduled cycle due to intolerance,and 34 patients had recurrence(16 patients of local recurrence,12 patients of liver metastasis,4 patients of peritoneal metastasis,and 2 patients of bone metastasis),and 41 patients in the follow-up group(18 patients of local recurrence,14 patients of liver metastasis,6 patients of peritoneal metastasis,2 patients of lung metastasis,1patient of bone metastasis).1.Univariate analysis found that tumor diameter,positive lymph node degree of differentiation,vascular invasion,adjuvant chemotherapy,postoperative CA199 and CEA have a certain relationship with postoperative DFS of pancreatic cancer(P<0.05).Multivariate analysis suggests that tumors diameter>2.6 cm,positive lymph nodes,poorly differentiated tumors,vascular infiltration,and unadjuvant chemotherapy are independent risk factors of shorter DFS.2.The median DFS of the GA group and the follow-up group was 14.8 months VS7.1 months(P<0.01).The K-M survival curve was statistically significant.Compared with the follow-up group,the GA group significantly improved the disease-free survival time and delayed tumor recurrence.3.Among the patients with stage I pancreatic cancer,there were 12 cases in the study group and 11 cases in the control group.The median DFS was 13.8 months VS11.8 months(P>0.05);Among the patients with stage II pancreatic cancer,there were27 patients in the study group and 33 patients in the follow-up group.The median DFS was 15.7 months VS 7.1 months(P<0.05);Among the patients with stage Ⅲ pancreatic cancer,there were 6 cases in the study group and 4 cases in the control group.the median DFS was 8.7 months VS 3.3 months(P<0.05).Conclusion:1.Multivariate analysis suggested that tumor diameter>2.6cm,positive lymph nodes,poorly differentiated tumors,vascular infiltration,and unadjuvant chemotherapy were independent risk factors of shorter DFS,which had an impact on postoperative recurrence.2.Patients with pancreatic cancer who received adjuvant chemotherapy using GA combined regimen significantly improved their disease-free survival,compared to those who did not receive chemotherapy.3.StageⅡ,Ⅲ patients with pancreatic cancer using GA scheme significantly delayed tumor recurrence,Stage I patients with pancreatic cancer had a little effects on tumor recurrence time.Preoperative and postoperative evaluation of patients with resectable pancreatic cancer who may have high risk factors for recurrence has a positive effect on the diagnosis and treatment of pancreatic cancer.GA combined regimen is an alternative adjuvant chemotherapy for pancreatic cancer after surgery,which can effectively delay tumor recurrence,improve disease-free survival and have a certain influence on the prognosis of patients. |
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