Prognostic significance of skeletal muscle decrease in unresectable pancreatic cancer: Survival analysis using the Weibull exponential distribution model
Prognostic significance of skeletal muscle decrease in unresectable pancreatic cancer: Survival analysis using the Weibull exponential distribution model
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DOI：
10.1016/j.pan.2021.03.002
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发表时间：
2021-08-04
期刊：
影响因子：
3.6
通讯作者：
Okumura, Toshikatsu
中科院分区：
文献类型：
--
作者：
Sato, Hiroki;Goto, Takuma;Okumura, Toshikatsu
背景/目的：胰腺导管腺癌(PDA)手术切除后，骨骼肌质量和功能的减少与预后不良有关。这项研究评估了骨骼肌量减少是否会影响PDA的结果。方法：对112例不能手术切除的晚期动脉导管未闭患者的临床资料进行回顾性分析。从患者的医疗记录中检索年龄、性别、血液学检查信息，包括全身炎症标志物和营养评估生物标志物，以及骨骼肌块和内脏脂肪组织的成像参数。使用风险比和Akaike信息标准(AIC)比较了Cox、weibull和标准化指数模型的效率。结果：威布尔、COX和标准化指数模型分析结果显示，低骨骼肌重、东部合作肿瘤组的表现状态(PS)和需要胆汁引流与死亡风险最高，其次是癌胚抗原(CEA)水平和腹水的存在。威布尔指数分布的四个显著参数的AIC值最低(222.3)，低于COX模型(653.7)和标准化指数模型(265.7)。我们建立了一个用威布尔指数分布估计一年生存概率的模型。结论：低骨骼肌指数、PS、胆汁引流要求、CEA水平和有无腹水是预测化疗后患者生存不良的独立因素。使用参数方法改进的生存模型可以准确地预测晚期PDA患者的预后。(C)2021年IAP和EPC。爱思唯尔出版，版权所有。
:Background/objectives: Decrease in skeletal muscle mass and function is associated with a poor prognosis following surgical resection of pancreatic ductal adenocarcinomas (PDAs). This study evaluated whether skeletal muscle mass decrease affects PDA outcomes. Methods: Data of 112 patients with advanced and unresectable PDA who underwent chemotherapy in a single institution were retrospectively analyzed. Information on age, sex, hematological investigations, including systemic inflammation-based markers and nutritional assessment biomarkers, and imaging parameters of skeletal muscle mass and visceral adipose tissue were retrieved from the patients' medical records. The efficiency of the Cox, Weibull, and standardized exponential models were compared using hazard ratios and the Akaike Information Criterion (AIC). Results: Results from the Weibull, Cox, and standardized exponential model analyses indicated that low skeletal muscle mass, Eastern Cooperative Oncology Group performance status (PS), and the requirement of biliary drainage were associated with the highest risk of death, followed by carcinoembryonic antigen (CEA) levels and the presence of ascites. The AIC value from the four significant parameters was lowest for the Weibull-exponential distribution (222.3) than that of the Cox (653.7) and standardized exponential models (265.7). We developed a model for estimating the 1-year survival probability using the Weibull-exponential distribution. Conclusions: Low-skeletal muscle index, PS, requirement of biliary drainage, CEA levels, and presence of ascites are independent factors for predicting poor patient survival after chemotherapy. Improved survival modeling using a parametric approach may accurately predict the outcome of patients with advanced-stage PDA. (c) 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved.