Analysis Of Risk Factors For Recurrence After Pancreatoduodenectomy

Objective:Through the first hospital of jilin university four years of pancreatic ductal adenocarcinoma of the head of pancreaticoduodenal resection(pancreaticoduodenectomy,PD)summarized the clinical data of patients,analysis line PD after surgical removal of the pancreatic head carcinoma associated with tumor recurrence and prognosis of patients with risk factors,factors on patients with predicted postoperative survival and better guide the clinical diagnosis and treatment.Method:Retrospective analysis in January 2013 to December 2016,63 cases of pancreatic ductal adenocarcinoma of the head of pancreaticoduodenal resection(PD)in patients with clinical data,including general information(age,gender,etc.),preoperative,postoperative pathologic results and serologic testing whether postoperative radiation and chemotherapy,etc.Observation indexes :(1)preoperative examination results: serum total bilirubin,albumin value,tumor markers(mainly CA19-9,CA125,CEA,etc).(2)surgical data: intraoperative hemorrhage,postoperative complications(pancreatic fistula,biliary fistula,delayed gastric emptying,abdominal infection,bleeding,etc.).(3)pathological examination results: tumor differentiation degree,lymph node metastasis,and vascular invasion.(4)follow-up results: tumor recurrence and postoperative survival.Follow-up outpatient and telephone follow-up were conducted.The follow-up was performed every 3 months for 1 year,followed by 1 year after 1 year,followed by a recurrence of tumor or death of the patient.Follow-up included medical history,physical examination,laboratory examination(including CA19-9,CA125,CEA,liver function,blood routine,etc.)and imaging examination(abdominal ultrasound,abdominal CT or MRI,etc.).If a recurrence is suspected,it can be checked in advance.The diagnosis of recurrence was mainly based on imaging findings,tumor markers and clinical manifestations.Data using Excel 2007,adopting SPSS 22.0 statistical analysis software,count data using frequency or rate,said early recurrence risk factors analysis of single factor using chi-square,multi-factor analysis using binary unconditioned Logistic regression;COX proportional regression was used in the analysis of single factor and multifactor in postoperative survival analysis.The survival curve was plotted using kaplan-meier method;p <0.05 was considered as statistically significant.Result:This study followed 63 patients with pancreatic ductal adenocarcinoma of the head,the longest follow-up time was 38.0 months and the median follow-up time of 11.0 months,there're a total of 3 patients lost to follow-up process,lost to follow-up rate was 4.76%,followed up a year a total of 37 cases of recurrence,the recurrence rate of 58.73% a year,the follow-up of the communist party of China a 53 patients had a relapse,the recurrence rate was 84.13%.The postoperative survival time was 11.00(9.47~12.53).The recurrence rate was 41.27%,20.11% and 8.94%,respectively,1 year,2 years and 3 years after surgery.All patients were divided into early relapse group and non-early recurrence group according to whether recurrence occurred within one year after surgery.The results of single factor analysis showed that age,CA19-9,CA125,CEA,albumin,vascularization,lymph node metastasis,tumor differentiation and postoperative chemotherapy were the risk factors for early postoperative recurrence.Multiariable Logistic regression analysis to the above factors,the results showed that CA125,vascular metastasis,lymph node metastasis,tumor differentiation degree and postoperative chemotherapy are independent risk factors for early postoperative recurrence.The patients' general information,preoperative laboratory data,intraoperative and postoperative pathology,check whether the results and postoperative chemotherapy for single factor analysis,the results showed that age,CA19-9,CA125,CEA,albumin,vascular metastasis,lymph node metastasis,tumor differentiation degree and postoperative chemotherapy was pancreatic ductal adenocarcinoma of the head the influence factors of postoperative relapse-free survival in patients with PD,(p< 0.05).Then these factors using COX proportional hazards regression model is analyzed,the results suggest age,CA19-9,albumin,vascular metastasis,tumor differentiation degree,whether postoperative chemotherapy associated with relapse-free survival rate,can be considered independent risk factors.Conclusion:1.CA125,vascular metastasis,lymph node metastasis,tumor differentiation and postoperative chemotherapy are independent risk factors for early postoperative recurrence.2.Age,CA19-9,albumin,vascular metastasis,degree of tumor differentiation,and postoperative chemotherapy are independent risk factors influencing postoperative survival without recurrence.