Prognostic value of site-specific metastases in pancreatic adenocarcinoma: A Surveillance Epidemiology and End Results database analysis.
Prognostic value of site-specific metastases in pancreatic adenocarcinoma: A Surveillance Epidemiology and End Results database analysis.
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DOI：
10.3748/wjg.v23.i10.1872
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发表时间：
2017-03-14
影响因子：
4.3
通讯作者：
Abdel-Rahman O
中科院分区：
文献类型：
--
作者：
Oweira H;Petrausch U;Helbling D;Schmidt J;Mannhart M;Mehrabi A;Schöb O;Giryes A;Decker M;Abdel-Rahman O
评估在监测、流行病学和最终结果（SEER）数据库中登记的转移性胰腺癌患者中部位特异性转移的预后价值。通过SEER*Stat程序查询SEER数据库（2010-2013），根据转移部位确定转移性胰腺腺癌的表现、治疗结果及预后。本研究根据转移部位（肝、肺、骨、脑、远端淋巴结）对转移性胰腺腺癌患者进行分类。我们采用卡方检验比较不同转移部位的临床病理特征。我们使用Kaplan-Meier分析和log-rank检验进行生存比较。我们采用Cox比例模型对患者群体进行多变量分析；产生相应95%CI的风险比。如果双尾P值< 0.05，则认为具有统计学意义。在2010-2013年期间，共有13233名IV期胰腺癌患者和已知的远处转移部位被确定，并被纳入当前的分析。与孤立性肝转移患者相比，孤立性远端淋巴结累及或肺转移患者的总体生存率和胰腺癌特异性生存率更高（总体生存率：肺与肝转移：P < 0.0001；远端淋巴结与肝转移：P < 0.0001）（胰腺癌特异性生存率：肺与肝转移：P < 0.0001；远端淋巴结与肝转移：P < 0.0001）。多因素分析显示，年龄< 65岁、白种人、已婚、女性；原发肿瘤的手术和转移性疾病的手术与更好的总生存率和胰腺癌特异性生存率相关。胰腺腺癌患者孤立性肝转移的预后比孤立性肺或远处淋巴结转移的预后差。需要进一步的研究来确定可能从原发肿瘤和/或转移性疾病的局部治疗中获益的高度选择的患者亚群。
To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreatic carcinoma registered within the Surveillance, Epidemiology and End Results (SEER) database. SEER database (2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases (liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailed P value < 0.05 was achieved. A total of 13233 patients with stage IV pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases (for overall survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001) (for pancreatic cancer-specific survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival. Pancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.