Prognostic factors following curative resection for pancreatic adenocarcinoma - A population-based, linked database analysis of 396 patients
Prognostic factors following curative resection for pancreatic adenocarcinoma - A population-based, linked database analysis of 396 patients
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DOI：
10.1097/00000658-200301000-00011
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发表时间：
2003-01-01
影响因子：
9
通讯作者：
Earle, CC
中科院分区：
文献类型：
--
作者：
Lim, JE;Chien, MW;Earle, CC
目的利用前瞻性收集的基于人群的数据，分析影响胰腺癌根治性切除术后长期生存的预后因素。摘要背景资料已有多项研究分析了胰腺癌根治性切除术后长期生存的决定因素，但大多数都是单一机构的图表回顾，结果不一致。方法这项回顾性队列研究调查了1991年1月至1996年12月期间396名符合医疗保险条件的非转移性胰腺癌患者，他们在11个生存、流行病学和最终结果(SEER)登记中的一个登记中接受了具有治疗意图的手术切除。结果总体研究人群的中位生存期为17.6个月，1年和3年生存率分别为60.1%和34.3%。随着时间的推移，存活率似乎正在逐渐提高，同时在教学中心接受手术的患者比例也在上升。单因素分析显示，显著降低生存率的预后变量包括非裔美国人种族、不在教学医院接受治疗、缺乏辅助放化疗，以及组织病理学因素，包括肿瘤直径大于2厘米、组织学分级中等至差以及淋巴结转移阳性。较高的社会经济地位与接受辅助治疗的可能性增加和总存活率的提高有关。多因素分析显示，生存的最强预测因素是辅助联合放化疗、小肿瘤(
ObjectiveTo analyze prognostic factors influencing pancreatic cancer survival following curative resection, using prospectively collected, population-based data.Summary Background DataSeveral studies have analyzed the determinants of long-term survival in postresection pancreatic cancer patients, but the majority of these have been single-institutional chart reviews yielding inconsistent results.MethodsThis retrospective cohort study examined 396 Medicare-eligible patients over age 65 who were diagnosed with nonmetastatic pancreatic adenocarcinoma and who underwent surgical resection with curative intent while residing in one of the 11 Survival, Epidemiology, and End Results (SEER) registries between January 1991 and December 1996. Linked Medicare data provided information on treatment and comorbidity, while linked census tract data supplied sociodemographic characteristics.ResultsMedian survival for the overall study population was 17.6 months, with 1- and 3-year survival rates of 60.1% and 34.3%, respectively. Survival appears to be gradually improving over time, concomitant with a rise in the proportion of patients undergoing surgery in teaching centers. Prognostic variables significantly diminishing survival on univariate analysis included African American race, treatment not in a teaching hospital, lack of adjuvant chemoradiation therapy, as well as histopathologic factors that included tumor size larger than 2 cm in diameter, moderate to poor histologic grade, and positive lymph node metastases. Higher socioeconomic status was associated both with an increased likelihood of receiving adjuvant therapy and improved overall survival. Multivariate analyses indicated the strongest predictors of survival were adjuvant combined chemoradiotherapy, small tumors (