Prognostic Factors Of Pancreatic Cancer And The Construction Of Nomogram Model

Objective:To discuss the major dangerous elements affecting the surgical prognosis of patients with pancreatic ductal adenocarcinoma（PDAC）,and to establish a nomogram model to provide a theoretical basis for the prognosis of PDAC.Methods:To summarize the clinical information and follow-up situation of 139patients who underwent surgery for PDAC in the first hospital of Lanzhou University from January 2012 to December 2019.The author collected the general information,preoperative laboratory examination results,postoperative pathological features,postoperative complications and treatment of the patients.Univariate analysis was used to learn the latent variables affecting postoperative recurrence and death in PDAC patients.Kaplan-Meier method was selected to compute the survival time of patients and draw their survival curve.Multifactorial analysis was used to evaluate the risk factors that might influence the prognosis of PDAC.According to the results of multivariate regression analysis,the prognostic nomogram model of PDAC was established.Results:1.There are 139 patients with PDAC and mDFS was 7.7 months.The disease-free survival rate at 1 and 2 years were 23.7%and 9.4%,respectively.The mOS was 15 months,and the overall survival rate was 65.5%and 20.9%at 1 and 2 years,respectively.2.COX multivariate regression analysis showed that TBIL,TG,PLR,degree of tumor differentiation,lymph node stage,TNM stage,margin status and postoperative chemotherapy were the independent risk factors for DFS（P<0.05）.TBIL,CA19-9≥35U/L,PLR,MLR,degree of tumor differentiation,lymph node stage,TNM stage,margin status and postoperative chemotherapy were the independent risk factors for OS（P<0.05）.3.Serological index Kaplan-Meier survival curve results:The mDFS of TBIL≥34.2mol/L group was 7.0 months,and that of TBIL<34.2mol/L group was 9.3months（P=0.049）.The mOS of TBIL≥34.2mol/L group was 13.8 months,and that of TBIL<34.2mol/L group was 16.2 months（P=0.035）.The mDFS with TG≥1.8 mmol/L was 5.8 months,and there was no statistical difference between the mDFS with TG<1.8 mmol/L（P=0.755）.MDFS was 7.0 months for PLR≥150 and 8.4 months for PLR<150（P=0.014）;MOS for PLR≥150 was 13.6 months and mOS for PLR<150 was 17.3months（P=0.002）.MOS of CA19-9≥35 U/m L was 13.0 months,and mOS of CA19-9<35 U/m L was 18.5 months（P=0.003）.MOS for MLR≥0.25 was 13.8 months,and mOS for MLR<0.25 was 16.3 months（P=0.033）.4.Tumor pathology Kaplan-Meier survival curve results:The mDFS of high,medium and low differentiation groups was 15.8,8.0 and 4.7 months（P<0.001）,respectively.The mOS was 22.9 months,15.0 months and 10.0 months in high,medium and low tumor differentiation groups（P<0.001）.The mDFS of lymph node stages N₀,N₁ and N₂ were 10.3,6.8 and 5.4 months（P=0.001）.MOS of lymph node stage N₀,N₁and N₂ were 19.3,13.2 and 12.6 months（P<0.001）.The mDFS of stageⅠ,ⅡandⅢwere 10.1,7.0 and 5.6 months（P=0.003）,respectively.The mOS of stageⅠ,ⅡandⅢwas 19.3 months,13.2 months and 12.6 months,respectively（P<0.001）.MDFS of R0was 4.6 months,and mDFS of R1 was 10.3 months（P<0.001）;MOS of R1 was 9.3months,and mOS of R0 was 17.2 months（P<0.001）.5.Kaplan-Meier survival curve results of postoperative treatment:The mDFS was9.0 months after chemotherapy and 2.3 months without chemotherapy（P<0.001）;The mOS was 17.3 months after chemotherapy and 6.2 months without chemotherapy（P<0.001）.6.The prognostic rosette model of PDAC was based on COX multivariate analysis.It showed that the AUC value verified internally by ROC was 0.639,indicating that the model had good discrimination ability.Conclusion:The independent DFS risk factors affecting PDAC included TBIL,TG,PLR,degree of tumor differentiation,lymph node stage,TNM stage,margin status,and postoperative chemotherapy.The independent risk factors affecting OS of pancreatic ductal adenocarcinoma include TBIL,CA19-9,PLR,MLR,degree of tumor differentiation,lymph node stage,TNM stage,margin status,and postoperative chemotherapy.The nomogram model established on the basis of COX regression analysis has certain significance.Therefore,treatment of the risk factors mentioned above is expected to improve the prognosis of patients and prolong DFS and OS.