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Impact of complications after resection of pancreatic cancer on disease recurrence and survival, and mediation effect of adjuvant chemotherapy: nationwide, observational cohort study

医学 危险系数 胰腺癌 内科学 置信区间 癌症 比例危险模型 外科 辅助治疗 队列研究 化疗 胃肠病学
作者
Anne Claire Henry,Jelle C. van Dongen,Iris W J M van Goor,F. Jasmijn Smits,Anne Nagelhout,Marc G. Besselink,Olivier R Busch,Bert A Bonsing,Koop Bosscha,Ronald M van Dam,Sebastiaan Festen,Bas Groot Koerkamp,Erwin van der Harst,Ignace H de Hingh,Marion van der Kolk,Mike S L Liem,Vincent E de Meijer,Gijs A Patijn,Daphne Roos,Jennifer M Schreinemakers,Fennie Wit,Lois A. Daamen,Hjalmar C van Santvoort,I Quintus Molenaar,Casper H J van Eijck
出处
期刊:BJS open [Wiley]
卷期号:7 (2)
标识
DOI:10.1093/bjsopen/zrac174
摘要

Abstract Background The causal pathway between complications after pancreatic cancer resection and impaired long-term survival remains unknown. The aim of this study was to investigate the impact of complications after pancreatic cancer resection on disease-free interval and overall survival, with adjuvant chemotherapy as a mediator. Methods This observational study included all patients undergoing pancreatic cancer resection in the Netherlands (2014–2017). Clinical data were extracted from the prospective Dutch Pancreatic Cancer Audit. Recurrence and survival data were collected additionally. In causal mediation analysis, direct and indirect effect estimates via adjuvant chemotherapy were calculated. Results In total, 1071 patients were included. Major complications (hazards ratio 1.22 (95 per cent c.i. 1.04 to 1.43); P = 0.015 and hazards ratio 1.25 (95 per cent c.i. 1.08 to 1.46); P = 0.003) and organ failure (hazards ratio 1.86 (95 per cent c.i. 1.32 to 2.62); P < 0.001 and hazards ratio 1.89 (95 per cent c.i. 1.36 to 2.63); P < 0.001) were associated with shorter disease-free interval and overall survival respectively. The effects of major complications and organ failure on disease-free interval (−1.71 (95 per cent c.i. −2.27 to −1.05) and −3.05 (95 per cent c.i. −4.03 to −1.80) respectively) and overall survival (−1.92 (95 per cent c.i. −2.60 to −1.16) and −3.49 (95 per cent c.i. −4.84 to −2.03) respectively) were mediated by adjuvant chemotherapy. Additionally, organ failure directly affected disease-free interval (−5.38 (95 per cent c.i. −9.27 to −1.94)) and overall survival (−6.32 (95 per cent c.i. −10.43 to −1.99)). In subgroup analyses, the association was found in patients undergoing pancreaticoduodenectomy, but not in patients undergoing distal pancreatectomy. Conclusion Major complications, including organ failure, negatively impact survival in patients after pancreatic cancer resection, largely mediated by adjuvant chemotherapy. Prevention or adequate treatment of complications and use of neoadjuvant treatment may improve oncological outcomes.
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