Disparities in survival by stage after surgery between pancreatic head and body/tail in patients with nonmetastatic pancreatic cancer

Zhenjiang Zheng; Mojin Wang; Chunlu Tan; Yonghua Chen; Jie Ping; Rui Wang; Xubao Liu

doi:10.1371/journal.pone.0226726

Disparities in survival by stage after surgery between pancreatic head and body/tail in patients with nonmetastatic pancreatic cancer

PLoS One. 2019 Dec 19;14(12):e0226726. doi: 10.1371/journal.pone.0226726. eCollection 2019.

Authors

Zhenjiang Zheng¹, Mojin Wang², Chunlu Tan¹, Yonghua Chen¹, Jie Ping³, Rui Wang⁴, Xubao Liu¹

Affiliations

¹ Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
² Department of Gastrointestinal Surgery, Institute of Digestive Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
³ Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, United States of America.
⁴ Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

Abstract

Background: The survival of pancreatic cancer patients with lesions in different locations is unclear. In addition, the different surgery types for nonmetastatic pancreatic head cancer (PHC) or body/tail cancer (PBTC) have different prognostic influences. We analyzed the association by stage between tumor location (head vs. body/tail) and survival of nonmetastatic pancreatic cancer patients who underwent surgery.

Methods: We identified stages I to III pancreatic cancer patients who underwent surgery from 2004 through 2015 by using the Surveillance, Epidemiology, and End Results (SEER) database. The adjusted hazard ratio (HR) and 95% confidence interval (CI) for cancer-specific survival (CSS) were obtained using Cox regression.

Results: A total of 13517 patients or 86.6% had PHC. PHC patients were more likely to have an advanced tumor stage, higher tumor grade, and more frequent and a higher number of positive lymph nodes compared with PBTC patients. The PHC patients had a worse CSS than PBTC patients (P<0.001) and were predominantly at stage I (P = 0.008) and II (P = 0.004). Multivariate Cox regression analysis showed that PHC was an independent prognostic factor associated with a worse CSS in pancreatic cancer patients (HR 1.132, 95% CI 1.042-1.228, P = 0.003), predominantly at stage II (HR 1.128, 95% CI 1.030-1.235, P = 0.009).

Conclusion: At a resectable early stage, the PHC patients had a worse CSS than PBTC patients after surgery. PHC was an independent prognostic factor associated with worse survival in pancreatic cancer patients, predominantly at stage II.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Humans
Male
Middle Aged
Neoplasm Staging
Pancreas / pathology*
Pancreatic Neoplasms / epidemiology*
Pancreatic Neoplasms / pathology
Pancreatic Neoplasms / surgery
Survival Analysis

Grants and funding

This work was supported by the 1.3.5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (Grant no. ZY2017302 1-3-5); National Health and Family Planning Commission of Chengdu (Grant no. 2016002); Key Research projects of Department of science and Technology of Sichuan Province, China (Grant no. 2018SZ0403); and Popularization and Application Project of Sichuan Health and Family Planning Commission (Grant no. 18PJ387). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.