Abstract
ObjectiveIn this study, we retrieved the data available in the Surveillance, Epidemiology, and End Results database to identify the prognostic factors for patients with pancreatic head cancer who had undergone pancreaticoduodenectomy and developed a prediction model for clinical reference.MethodsWe screened the data between 1973 and 2015. Propensity score matching (PSM) was used to control for the confounding factors. Kaplan-Meier (log-rank test) curves were used to compare the survival rates. A nomogram was established using multifactorial Cox regression.ResultsIn total, 4099 patients were identified. Their median survival was 22 months, with 74.2%, 36.5%, and 26.2% survival after 1, 3, and 5 years, respectively. The median cancer-specific survival was 24.0 months, with 71.1%, 32.6%, and 21.9% survival after 1, 3, and 5 years, respectively. The results of the Cox proportional risk regression showed that age, insurance status, gender, histological type, degree of tissue differentiation, T and N stages, tumor size, extent of regional lymph node dissection, and postoperative radiotherapy or chemotherapy are independent factors affecting prognosis. PSM was used twice to eliminate any bias from the unbalanced covariates in the raw data. After PSM, the patients who had received postoperative radiotherapy were found to have a better survival prognosis and disease-specific survival prognosis than those who had not received radiotherapy [HR = 0.809, 95% CI (0.731–0.894), P < 0.001 and HR = 0.814, 95% CI (0.732–0.904), P < 0.001; respectively]. A similar result was observed for the patients who had received postoperative chemotherapy versus those who had not [HR = 0.703, 95% CI (0.633–0.78), P < 0.001 and HR = 0.736, 95% CI (0.658–0.822), P < 0.001, for survival and disease-specific survival prognoses, respectively]. Finally, the β coefficients of the Cox proportional risk regression were used to establish a nomogram.ConclusionAge, insurance status, gender, histological type, degree of differentiation, T and N stages, tumor size, regional lymph node dissection, and postoperative radiotherapy or chemotherapy are factors affecting the prognosis in pancreatic head cancer after pancreaticoduodenectomy. Postoperative radiotherapy and chemotherapy can improve patient survival. These still need to be further validated in the future.
Highlights
The new cases of pancreatic cancer in the United States in 2017 corresponded to 9% of all the cases of malignancies in the country
We evaluated the prognoses of patients in the SEER database who were diagnosed with primary pancreatic head cancer between 2010 and 2015
By applying the criteria stated above, this retrospective study initially identified that the SEER database had 7688 patients with stage M0 pancreatic head cancer who had undergone surgery between 2010 and 2015
Summary
The new cases of pancreatic cancer in the United States in 2017 corresponded to 9% of all the cases of malignancies in the country. Pancreaticoduodenectomy, known as the Whipple procedure, was first reported in 1935 by Whipple [3] This procedure is considered to be one of the most complex abdominal surgeries and characterized by high trauma and complication rates since it requires removal of numerous organs and reconstruction of the digestive tract, including the pancreas, biliary tract, and gastrointestinal tract. In the face of such a complex procedure with extremely high postoperative complications, new methods that can effectively and accurately predict the postoperative survival rate should be identified and evaluated to establish an optimal customized treatment strategy
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