CPDC及SEER数据库中胰腺癌术后患者预后因素的比较研究  

The comparison of prognosis factors after radical resection for pancreatic ductal adenocarcinoma between China Pancreas Data Center and SEER database

作　　者：胡浩 曲畅 田孝东[1] 杨尹默[1] Hu Hao;Qu Chang;Tian Xiaodong;Yang Yinmo(Department of General Surgery,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院普通外科,100034

出　　处：《中华外科杂志》2021年第9期770-776,共7页Chinese Journal of Surgery

基　　金：国家自然科学基金(81871954);北京市自然科学基金(7212111)。

摘　　要：目的比较中国胰腺疾病大数据中心(CPDC)及监测、流行病学和最终结果(SEER)数据库中胰腺癌术后患者的预后及其影响因素。方法回顾性分析CPDC 2016年1月至2017年12月、SEER数据库2014年1月至2015年12月收录的胰腺癌根治术后患者的临床资料。通过Kaplan-Meier、Log-rank、倾向性评分匹配等方法比较两个数据库患者的预后差异,通过Cox比例风险回归模型分析影响预后的因素。结果由CPDC和SEER数据库中分别提取1977例和2220例接受根治性手术的胰腺癌患者资料。CPDC中男性比例(60.90%,1204/1977)高于女性(39.10%,773/1977),而SEER数据库中男女比例约为1∶1(男性1112例,女性1108例)(χ^(2)=48.977,P<0.01)。两个数据库中45岁以下的胰腺癌患者比例均较小,占比最大的年龄段均为60~74岁,SEER数据库中≥75岁患者比例(24.28%,539/2220)高于CPDC(7.89%,156/1977)(χ^(2)=202.090,P<0.01);CPDC中45~59岁胰腺癌患者比例(33.69%,666/1977)高于SEER数据库(19.77%,439/2220)(χ^(2)=103.640,P<0.01)。两个数据库中胰头癌患者比例均大于胰体尾癌,且肿瘤最大径差异无统计学意义(W=2181502,P=0.740)。SEER数据库中患者的淋巴结清扫数目及转移淋巴结数目均多于CPDC(W=3265131、2954363,P值均<0.01);SEER数据库中淋巴结清扫数目≥15枚的患者比例(63.24%,1404/2220)高于CPDC(27.62%,546/1977)(χ^(2)=532.130,P<0.01)。CPDC中未接受辅助和(或)新辅助治疗患者的比例(57.16%,1130/1977)高于SEER数据库(24.91%,553/2220)(χ^(2)=451.390,P<0.01)。经倾向性评分匹配后,CPDC和SEER数据库中患者的中位生存期分别为24个月和23个月(Log-rank检验:χ^(2)=4.500,P=0.034)。Cox回归分析结果显示,两个数据库共同的独立预后因素包括年龄≥75岁、胰头癌、低分化与未分化癌、T分期、N分期等(P值均<0.05)。两个数据库中新辅助或辅助治疗均为预后的保护性因素(CPDC:Wald=27.082;SEER数据库:Wald=212.285;P值均<0.01),SEER数据库中年龄45Objectives To compare the prognosis of patients underwent radical resection for pancreatic ductal adenocarcinoma(PDAC)in Surveillance,Epidemiology,and End Results(SEER)database and China Pancreas Data Center(CPDC),and to compare the prognostic factors for PDAC in both databases.Methods The data of patients underwent radical resection for PDAC in CPDC from January 2016 to December 2017 and SEER database from January 2014 to December 2015 were retrospectively analyzed.The prognosis factors of patients in both databases were analyzed by Kaplan-Meier method,Log-rank method,and propensity score matching,respectively.And the Cox proportional hazard regression was used to analyze the independent prognosis factors for PDAC.Results There were 1977 cases and 2220 cases of pancreatic cancer that underwent radical resection from CPDC and SEER,respectively.There were more male patients(60.90%,1204/1977)than female patients(39.10%,773/1977)in CPDC,while nearly 1∶1 ratio(male:1112 cases,female:1108 cases)was observed between male and female in SEER database(χ^(2)=48.977,P<0.01).The proportion of patients under 45 years old was the smallest in both databases,and the age group with the most significant proportion was 60 to 74 years old.The ratio of patients over 75 years old in the SEER database(24.28%,539/2220)was higher than that in CPDC(7.89%,156/1977)(χ^(2)=202.090,P<0.01),while the proportion of patients between 45 and 59 years old in CPDC(33.69%,666/1977)was higher than that in SEER database(19.77%,439/2220)(χ^(2)=103.640,P<0.01).There were more pancreatic head cancers than body and tail cancers in both databases,and no statistical difference was found in tumor size between the two databases(W=2181502,P=0.740).More positive and examined lymph nodes were found in SEER patients(W=3265131,W=2954363,both P<0.01);and the proportion of patients who had at least 15 lymph nodes dissected was higher in SEER(63.24%,1404/2220)(χ^(2)=532.130,P<0.01).There were more patients without neoadjuvant or adjuvant therapy in CPDC(57.16%,1

关 键 词：胰腺肿瘤 预后 数据库 TNM分期 

分 类 号：R735.9[医药卫生—肿瘤]