Analysis Of Survival And Prognostic Factors In 625 Patients With Pancreatic Cancer

Objective: To investigate the effect of different factors on prognosis of patients with pancreatic cancer(PC).Methods: Clinical data of 625 patients with PC who treated in The Shengjing Hospital of China Medical University from January 2013 to December 2017 were retrospectively analyzed.The follow-up methods were Telephone,Short Messaging Service and consulting the patient's medical records.The age,gender,pain in back and loin,somking history,diabetes history,baseline CA199 level,CEA level,total bilirubin level,albumin level,the ratio of neutrophil to lymphocyte absolute value(NLR),operation procedurce,tumor location,tumor size,peripancreatic invasion,degree of weight loss,lymph node metastasis,hepatic metastasis,the number of distal organ metastasis and postoperative adjuvant chemotherapy were used as the research indicators.Kaplan-Meier method was used to calculate the survival rate and median overall survival time,and survival curves were drawn.Log-rank test(univariate analysis)was used for survival comparison between groups.Factors with statistical significance in univariate analysis were included in the Cox regression model for multivariate analysis.P<0.05 was considered statistically significant.If the continuous variables are normally distributed,they are represented by mean ± standard deviation,and T-test was conducted,otherwise,it was represented by the median,and the U-test was adopted.T-test or U-test was adopted to compare the mean values of two subgroups(pancreatic head cancer and pancreatic body/tail cancer).Some variables(e.g.,smoking history,diabetes history,CEA level,albumin level,NLR,degree of weight loss,peripancreatic invasion,etc.)were converted into categorical variable or ranked data.The chi-square test(Fisher's exact test)or Pearson chi-square test was used to compare the distribution of the two subgroups.By the end of follow-up,569 patients were followed up effectively,with a follow-up rate of 91%.The follow-up period was 1-75 months.The overall 1-,3-,and 5-year survival rates of 625 patients were 37.8%,15.1%,and 10.5%,respectively.The median overall survival(mOS)was 9.3 months(95%CI:8.5-10.1).The overall 1-,3-,and 5-year survival rates of patients undergoing radical resection were 51.0%,19.7%,and 12.4%,respectively,and the mOS was 12.3 months(95%CI:10.3-14.3).The overall 1-,3-,and 5-year survival rates of patients undergoing palliative operation were 18.9%,9.3%,and 0%,respectively,and the mOS was 6.0 months(95%CI:5.2-6.8).The overall 1-,3-,and 5-year survival rates of patients without surgery were 18.4%,8.5%,and 0%,respectively,and the mOS was 6.0 months(95%CI:5.3-6.7).Univariate analysis showed that age,baseline CA199 level,CEA level,total bilirubin level,albumin level,NLR,weight loss,peripancreatic invasion,operation procedure,tumor size,lymph node metastasis,hepatic metastasis,the number of distal organ metastasis and postoperative adjuvant chemotherapy were the relevant factors affecting the prognosis of PC(P<0.05);Multivariate analysis showed that baseline CA199 level,NLR,operation procedure,lymph node metastasis,the number of distal organ metastasis and postoperative adjuvant chemotherapy were independent factors affecting the prognosis of PC(P<0.05).Conclusion: Baseline CA199 level,NLR,operation procedure,lymph node metastasis,the number of distal organ metastasis and postoperative adjuvant chemotherapy are important prognostic factors for patients with PC.Radical resection and postoperative adjuvant chemotherapy can significantly improve the prognosis of patients with PC.