Effect of surgery on survival rate of elderly patients with pancreatic head cancer accompanied by lymph node metastasis

LI Lincheng

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Medical Journal of the Chinese People Armed Police Forces ›› 2025, Vol. 36 ›› Issue (5) : 369-375.

ORIGINAL ARTICLES

Effect of surgery on survival rate of elderly patients with pancreatic head cancer accompanied by lymph node metastasis

LI Lincheng

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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.

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pancreatic head cancer in elderly patients / lymph node metastasis / surgery / chemotherapy

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LI Lincheng. Effect of surgery on survival rate of elderly patients with pancreatic head cancer accompanied by lymph node metastasis[J]. Medical Journal of the Chinese People Armed Police Forces. 2025, 36(5): 369-375

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