MDCT影像特征联合血清肿瘤标志物评估胰腺导管腺癌患者生存预后:基于COX比例风险回归模型

Prediction of survival and prognosis of pancreatic ductal adenocarcinoma by MDCT features combined with serum tumor markers:based on COX proportional hazard regression model

目的:基于MDCT影像特征与血清肿瘤标志物预测胰腺导管腺癌(PDAC)生存预后。方法:回顾分析经病理证实的PDAC 82例,观察记录肿瘤标志物(CA19-9,CA125和CEA)、肿瘤大小、形态、成分、边缘、周围侵犯、淋巴结及远处转移等情况,采用COX回归模型和Kaplan-Meier法进行统计学分析。结果:单因素COX回归分析显示肿瘤标志物(HR:8.09,95%CI:2.77~23.66)、T分期(T2:HR=3.55,95%CI=1.24~10.16;T3:HR=4.35,95%CI=1.58~11.98;T4:HR=4.18,95%CI=1.54~11.36)、远处转移(HR:1.88,95%CI:1.12~3.15)和淋巴结转移(HR:2.87,95%CI:1.67~4.91)为预后预测因素;多因素COX回归模型显示,肿瘤标志物升高(HR:10.91,95%CI:3.24~36.73)、淋巴结转移(HR:1.93,95%CI:1.01~3.67)和远处转移(HR:2.77,95%CI:1.41~5.44)是影响PDAC患者生存预后的独立危险因素(P<0.05);PDAC患者中位生存时间为9个月,1年生存率为39.2%,5年生存率仅3.7%。结论:PDAC预后极差,肿瘤标志物的升高、淋巴结转移和远处转移是提示PDAC不良预后的独立危险因素。

Objective:The purpose was to explore the feasibility of predicting the survival and prognosis of pancreatic ductal adenocarcinoma(PDAC)based on MDCT imaging features and serum tumor markers.Methods:Eighty-two cases of PDAC confirmed by pathology were retrospectively analyzed.The serum tumor markers(CA19-9,CA125 and CEA),tumor size,shape,tumor texture,margin,adjacent invasion,lymph node and distant metastasis were analyzed.The COX regression model and Kaplan-Meier were used for statistical analysis.Results:Univariate COX regression analysis showed that tumor markers(HR:8.09,95%CI:2.77~23.66),T stage T2:HR=3.55,95%CI=1.24~10.16;T3:HR=4.35,95%CI=1.58~11.98;T4:HR=4.18,95%CI=1.54~11.36),distant metastasis(HR:1.88,95%CI:1.12~3.15)and lymph node metastasis(HR:2.87,95%CI:1.67~4.91)were prognostic factors.Multivariate COX regression model showed that elevation of tumor markers(HR:10.91,95%CI:3.24~36.73),lymph node metastasis(HR:1.93,95%CI:1.01~3.67)and distant metastasis(HR:2.77,95%CI:1.41~5.44)were independent risk factors for survival and prognosis of PDAC(P<0.05).The median survival time of PDAC was 9 months,the 1-year survival rate was 39.2%,and the 5-year survival rate was only 3.7%.Conclusion:The prognosis of PDAC is extremely poor.The increase of tumor markers,lymph node metastasis and distant metastasis are independent risk factors for poor prognosis of PDAC.