Predictive Model of Early Death of Resectable Pancreatic Ductal Adenocarcinoma After Curative Resection: A SEER-Based Study.
Predictive Model of Early Death of Resectable Pancreatic Ductal Adenocarcinoma After Curative Resection: A SEER-Based Study.
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可切除性胰腺导管腺癌根治性切除后早期死亡的预测模型：基于 SEER 的研究
DOI：
10.1177/10732748221084853
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Tian X
中科院分区：
文献类型：
--
作者：
Liu W;Ma Y;Tang B;Qu C;Chen Y;Yang Y;Tian X
本研究旨在通过分析根治性手术后早期死亡的可切除胰腺导管腺癌（R-PDAC）患者的临床特征，确定预测早期死亡的因素，并建立早期死亡的预测模型。这是监测、流行病学和最终结果 (SEER) 数据库中针对 R-PDAC 接受根治性手术切除的患者的一项回顾性研究。总生存期≤12个月的患者被分配为早期死亡组，1年以上的患者被分配为晚期死亡组。进行单变量和多变量逻辑回归以确定与早期死亡显着相关的因素。根据已确定的独立危险因素构建了早期死亡预测模型。共分析9695例患者，早期死亡总发生率为30.72%。多变量分析显示，与早期死亡显着相关的因素包括诊断时年龄、种族、婚姻状况、肿瘤部位、肿瘤大小、肿瘤分级、阳性淋巴结数量、检查淋巴结数量、阳性淋巴结比例、化疗和放疗。预测模型显示出良好的区分度，C 指数为 0.722（95% 置信区间：0.711-0.733），校准结果令人信服。我们开发了一种预测模型，可以轻松应用于根治性切除术后的 R-PDAC 患者，以预测 1 年内的死亡机会。对于早期死亡风险较高的患者，应考虑新辅助治疗。即使在根治性切除术后，也必须使用更积极的辅助化疗（联合或不联合放疗）以尽量减少早期死亡的机会。
This study aims to determine the factors that predict early death and establish a predictive model for early death by analyzing clinical characteristics of patients with resectable pancreatic ductal adenocarcinoma (R-PDAC) who die early after radical surgery. This was a retrospective study of patients who underwent radical surgical resection for R-PDAC in the Surveillance, Epidemiology, and End Results (SEER) database. Patients with overall survival ≤ 12 months were assigned as early death group and above 1 year as the late death group. Univariate and multivariate logistic regression was conducted to identify factors significantly associated with early death. An early death predictive model was constructed based on the identified independent risk factors. A total of 9695 patients were analyzed, and the total incidence of early death was 30.72%. Multivariable analysis showed that factors significantly associated with early death included age at diagnosis, race, marital status, tumor location, tumor size, tumor grade, number of positive lymph nodes, number of examined lymph nodes, positive lymph node ratio, chemotherapy, and radiotherapy. The predictive model showed good discrimination with a C-index of 0.722 (95% confidence interval: 0.711-0.733) and convincing calibration. We developed a predictive model that may be easily applied to patients with R-PDAC after radical resection to predict the chance of death within 1 year. For patients with high risk of early death, neoadjuvant therapy should be considered. Even after radical resection, more aggressive adjuvant chemotherapy (with or without combined radiotherapy) must be used to minimize the chance of early death.