Predictors of Early Mortality After Surgical Resection of Pancreatic Adenocarcinoma in the Era of Neoadjuvant Treatment
Predictors of Early Mortality After Surgical Resection of Pancreatic Adenocarcinoma in the Era of Neoadjuvant Treatment
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DOI：
10.1097/mpa.0000000000000731
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发表时间：
2017-02-01
期刊：
影响因子：
2.9
通讯作者：
Fernandez-del Castillo, Carlos
中科院分区：
文献类型：
--
作者：
Nipp, Ryan D.;Zanconato, Andrea;Fernandez-del Castillo, Carlos
目的：新辅助治疗越来越多地用于胰腺导管腺癌（PDAC）患者，但有些患者在切除术后出现早期死亡。我们试图确定PDAC切除术后早期死亡率的预测因素，并确定其与新辅助治疗的相互作用。方法：我们对2011年3月至2014年3月的PDAC切除术患者进行了回顾性研究。我们比较了那些在手术后一年内死亡的患者和那些存活超过一年的患者，以及那些接受新辅助治疗的患者和那些直接接受手术的患者。我们使用逻辑回归，以确定早期死亡率的预测因素，并确定其相互作用与新辅助therapy.Results：191例接受切除术，59（30.9%）在1年内死亡，79（41.4%）接受新辅助治疗。早期死亡患者年龄较大，合并症较多，淋巴结阳性的可能性较大。接受新辅助治疗的患者更年轻，合并症更低，更可能有前期不可切除的疾病。早期死亡率的预测因素包括：较高的合并症、低分化肿瘤分级和淋巴结阳性。我们发现，新辅助治疗缓和合并症和淋巴结阳性对早期死亡率risk.Conclusions的影响：我们确定了PDAC切除术后早期死亡率的预测因子，并确定了它们与新辅助治疗的相互作用。
Objectives: Neoadjuvant treatments are increasingly used for patients with pancreatic ductal adenocarcinoma (PDAC), yet some experience early mortality after resection. We sought to identify predictors of early mortality after PDAC resection and determine their interaction with neo-adjuvant therapy.Methods: We performed a retrospective study of patients with PDAC resection from March 2011 to March 2014. We compared those who died within one year after surgery to those living beyond 1 year, and those who received neoadjuvant therapy to those taken directly to surgery. We used logistic regression to identify predictors of early mortality and determine their interaction with neoadjuvant therapy.Results: Of 191 patients who underwent resection, 59 (30.9%) died within 1 year and 79 (41.4%) received neoadjuvant therapy. Early mortality patients were older, with higher comorbidity, and more likely to have lymph node positivity. Patients receiving neoadjuvant therapy were younger, with lower comorbidity, and more likely to have upfront unresectable disease. Predictors of early mortality included: higher comorbidity, poorly differentiated tumor grade, and lymph node positivity. We found that neoadjuvant therapy moderated the effects of comorbidity and lymph node positivity on early mortality risk.Conclusions: We identified predictors of early mortality after PDAC resection and determined their interaction with neoadjuvant therapy.