Establishment and application of a preoperative grading system for resectable pancreatic cancer
10.3969/j.issn.1001-5256.2022.10.023
- VernacularTitle:可切除胰腺癌术前评分分级体系的建立与应用
- Author:
Chengfang WANG
1
;
Zhijiang WANG
1
;
Weilin WANG
2
Author Information
1. Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
2. Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China;Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, China;Zhejiang Provincial Research Center for Diagnosis and Treatment of Liver Cancer, Hangzhou 310009, China;Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Diseases, Zhejiang University, Hangzhou 310009, China;Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou 310009, China
- Publication Type:Original Article_Pancreatic Diseases
- Keywords:
Pancreatic Neoplasms;
Neoplasm Recurrence, Local;
Risk Factors
- From:
Journal of Clinical Hepatology
2022;38(10):2325-2333
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the risk factors for early recurrence of resectable pancreatic cancer and the establishment and application of a grading system. Methods A retrospective case-control study was conducted among 303 patients with resectable pancreatic cancer who underwent radical resection in Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, from March 2015 to June 2021, and according to the presence or absence of early recurrence (within 6 months after surgery), the 283 patients directly operated on were divided into early recurrence group with 95 patients and non-early recurrence group with 188 patients; 20 patients who received neoadjuvant therapy before surgery were enrolled as neoadjuvant therapy group. Observation indicators included general information, preoperative imaging data, preoperative laboratory data, routine blood test/blood biochemistry and derived indicators, tumor markers, and coagulation markers, and follow-up was conducted to observe recurrence-free survival. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate Logistic regression analysis was used to investigate the risk factors for early recurrence in patients with pancreatic cancer, and the receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of each indicator. The Kaplan-Meier curve was plotted, and the Log-rank test was used for comparison of recurrence-free survival time between groups. Results The univariate analysis showed that compared with the non-early recurrence group, the early recurrence group had significantly lower body mass index (BMI) and triglyceride and significantly higher CA19-9, CA242, CA125, and plasma fibrinogen (all P < 0.05). The multivariate logistic regression analysis showed that BMI (odds ratio [ OR ]=1.150, 95% confidence interval [ CI ]: 1.038-1.273, P =0.007), plasma fibrinogen ( OR =2.513, 95% CI : 1.355-4.663, P =0.003), and CA242 ( OR =2.482, 95% CI : 1.067-5.774, P =0.035) were independent risk factors for early recurrence in patients with resectable pancreatic cancer. BMI, CA242, and plasma fibrinogen were included in the grading system, with a cut-off value of 23.00 kg/m 2 , 30.0 U/mL, and 4.00 g/L, respectively. BMI < 23.00 kg/m 2 was counted as 1 point, otherwise it was counted as 0 point; CA242≥30.00 U/mL was counted as 1 point, otherwise it was counted as 0 point; plasma fibrinogen ≥4.00 g/L was counted as 1 point, otherwise it was counted as 0 point; the total score was 0-3 points. The patients in both the early recurrence group and the non-early recurrence group were scored, and the results showed that the early recurrence group had a significantly higher score than the non-early recurrence group [2(0-3) points vs 1(0-3) point, Z =-5.339, P < 0.001]. The Kaplan-Meier curve analysis showed that there was a significant difference in time to recurrence between groups ( χ 2 =28.116, P < 0.001), and the higher the score, the shorter the expected time to recurrence. The patients with 3 points were defined as high-risk group and those with 0-2 points were defined as low-risk group, and the early recurrence rate was 84.6% in the high-risk group and 31.2% in the low-risk group. Conclusion The grading system based on BMI, plasma fibrinogen, and CA242 can reliably predict postoperative recurrence.
