| Objective:Pancreatic ductal adenocarcinoma is a highly malignant tumor of the digestive system,the incidence of which is increasing yearly.Because of the insidious onset of pancreatic ductal adenocarcinoma,most patients are diagnosed at an advanced stage and often lose the opportunity for surgery,and even if a small percentage of patients have the opportunity to undergo radical surgery,these patients will recur and metastasize within a very short period of time.It is for these reasons that the mortality rate of patients with pancreatic ductal adenocarcinoma has been among the highest for various malignant tumors,posing a great threat to the health of people worldwide.Laparoscopic pancreaticoduodenectomy is a standard procedure for radical treatment of pancreatic head cancer,which is the "crown jewel" of general surgery because of its difficulty and high risk.CA19-9 and CA242 are important laboratory tests for the diagnosis of pancreatic ductal adenocarcinoma,with elevated levels varying from patient to patient.Can preoperative CA19-9 and CA242 be important suggestive predictors of recurrence and survival after laparoscopic pancreaticoduodenectomy in patients with pancreatic ductal adenocarcinoma? Can we improve the prognosis of patients who are at high risk of recurrence by using these indicators for early intervention as well as precise treatment? By reviewing the literature,this issue has been rarely reported,and this study will examine this issue using data from our department.Methods:This study retrospectively analyzed the clinicopathological data of 141 patients who underwent laparoscopic pancreaticoduodenectomy at the Second Department of Hepatobiliary and Pancreatic Surgery,First Hospital of Jilin University from May 2016 to August 2020 and had postoperative pathologically confirmed pancreatic ductal adenocarcinoma.These patients were followed up until December 2021 by regular outpatient review or telephone follow-up,and risk factors for overall survival and recurrence-free survival were discussed using commonly used survival analysis methods and statistical tests of variability.Results:The 141 patients enrolled in the study were divided into the "group with elevated CA19-9 and CA242" and the "group with normal CA19-9 or CA242" according to the presence or absence of concurrent elevation of CA19-9 and CA242.There were 84(59.57%)and 57(40.43%)patients in the two groups,respectively.The median followup time for all patients was 15.3 months.During follow-up,98 patients relapsed and 93 patients died,with a median relapse-free survival time of 12.6 months and a median overall survival time of 16.3 months.The chi-square test showed that vascular invasion(P<0.001),lymph node metastasis(P=0.019),and tumor diameter ≥3 cm(P=0.008)were different in the "group with elevated CA19-9 and CA242" and the "group with normal CA19-9 or CA242 "Univariate and multivariate Cox regression analyses showed that vascular invasion,lymph node metastasis,elevated preoperative CA242 and CA19-9,and tumor diameter≥3 cm were risk factors for overall survival in patients with pancreatic ductal adenocarcinoma(all P < 0.001).Univariate and multivariate Cox regression analyses showed that vascular invasion,lymph node metastasis,elevated preoperative CA242 and CA19-9,and tumor diameter≥3 cm were risk factors for recurrence-free survival in patients with pancreatic ductal adenocarcinoma(all P < 0.001).Conclusion:1.Vascular invasion,lymph node metastasis,elevated preoperative CA242 and CA19-9,and tumor size ≥3 cm are risk factors for overall survival in patients with pancreatic ductal adenocarcinoma2.Vascular invasion,lymph node metastasis,elevated preoperative CA242 and CA19-9,and tumor size ≥3 cm were risk factors for recurrence-free survival in patients with pancreatic ductal adenocarcinoma... |
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