目的 探讨伴有淋巴结转移老年胰头癌患者接受手术切除对生存率的影响。方法 收集SEER数据库中2005-2020年诊断为伴有淋巴结转移的老年胰头癌患者的临床资料。通过倾向评分匹配（PSM）减少组间偏倚,采用单因素χ²检验比较临床病理特征差异。采用Kaplan-Meier法绘制两组的生存曲线,Log-rank法进行组间比较。在考虑竞争风险的前提下,分别采用Gray检验和Fine-Gray模型进行单因素及多因素分析。结果 共纳入1692例伴有淋巴结转移的老年胰头癌患者,其中1356例（80.14%）接受手术治疗,336例（19.86%）未接受手术治疗。经1∶1倾向评分匹配均衡基线资料后,每组各223例。生存分析结果显示,手术组的总生存期（OS）明显优于非手术组。进一步亚组分析显示,不同年龄、肿瘤分级、T分期和肿瘤大小分组中,手术组的生存获益更多。不同组织学类型的Cox分析显示,行手术治疗的腺癌（HR=0.33,95%CI：0.26~0.42,P<0.05）和浸润导管癌（HR=0.20,95%CI：0.10~0.43,P<0.05）患者的生存率更高。多因素竞争风险分析显示,肿瘤分级、化疗、组织学类型和淋巴结比率（LNR）是接受手术切除的伴有淋巴结转移的老年胰头癌OS的独立危险因素（P<0.05）。累积发生曲线表明术后化疗能够显著改善伴有淋巴结转移的老年胰头癌患者的预后（P<0.05）。而放化疗联合治疗与单独化疗比较,患者的生存率差异无统计学意义。结论 对于年龄≥75岁的伴有淋巴结转移的胰头癌患者,接受手术切除可提高生存率,然而并不推荐术后常规放疗。
Abstract
Objective To explore the effect of surgical resection on the survival rate of elderly patients with pancreatic head cancer accompanied by lymph node metastasis. Methods Clinical data of elderly patients with pancreatic head cancer diagnosed with lymph node metastasis from 2005 to 2020 in the SEER database were collected. Propensity score matching（PSM）was utilized to minimize the bias between groups, and univariate χ² test was performed to compare the differences in clinicopathological characteristics. The survival curves of the two groups were plotted by the Kaplan-Meier method, and the comparison between groups was conducted by Log-rank method. On the premise of considering the competing risk, univariate and multivariate analyses were respectively performed using the Gray test and the Fine-Gray model. Results A total of 1692 elderly patients with pancreatic head cancer accompanied by lymph node metastasis were included. Among all the patients, 1356（80. 14%）underwent surgical resection while 336（19. 86%）did not. After 1:1 PSM to balance baseline characteristics, 223 patients were included in each group. The results of survival analysis showed significantly improved overall survival（OS）in the surgical group compared to non-surgical group. Further subgroup analysis revealed that in subgroups classified by different ages, tumor grades, T stages, and tumor sizes, the surgical group achieved greater survival benefits. Cox analysis of different histological types indicated that the survival rates of patients with adenocarcinoma（HR=0. 33, 95%CI: 0. 26~0. 42, P<0. 05）and infiltrating ductal carcinoma（HR=0. 20, 95%CI: 0. 10~0. 43, P<0. 05）who underwent surgical treatment were higher. Multivariate competing risk analysis demonstrated that tumor grade, chemotherapy, histological type, and lymph node ratio（LNR）were independent risk factors for OS in patients undergoing surgery（P<0. 05）. The cumulative incidence curves indicated that postoperative chemotherapy could significantly improve prognosis（P<0. 05）, while combined chemoradiotherapy showed no statistically significant difference compared with chemotherapy alone. Conclusion For pancreatic head cancer patients aged 75 years and over with lymph node metastasis, surgical resection can improve the survival rate, but conventional postoperative radiotherapy is not recommended.
关键词
老年胰头癌 /
淋巴结转移 /
手术 /
化疗
Key words
pancreatic head cancer in elderly patients /
lymph node metastasis /
surgery /
chemotherapy
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