Background: Little is known about the characteristics of early pancreatic cancer. We aimed to identify the characteristics, clues for early detection, and prognostic factors for early pancreatic cancer by analyzing a large number of patients with stage 1 pancreatic cancer. Methods: A clinical data warehouse that includes databases of all the medical records of eight academic institutions was used to select and analyze patients with pancreatic cancer that had been diagnosed from January 2010 to May 2023. Results: In total, 257 stage 1 pancreatic cancer patients were included. There were 134 men (52%), and the average age was 67.2 ± 9.9 years. Compared to patients with stage 1B pancreatic cancer (2–4 cm), patients with stage 1A pancreatic cancer (≤2 cm) had more tumors in the body and tail than in the head (p= 0.028), more new-onset diabetes and less old diabetes (p= 0.010), less jaundice (p= 0.020), more follow-up of IPMN (intraductal papillary mucinous neoplasm,p= 0.029), and more histories of acute pancreatitis (p= 0.013). The pathological findings showed that stage 1A pancreatic cancer involved more IPMNs (p< 0.001) and lower pancreatic intraepithelial neoplasia (p= 0.004). IPMN was present in all 13 pancreatic tumors that were smaller than 1 cm. In multivariate analysis, positive resection margin (odds ratio [OR] 1.536,p= 0.040), venous invasion (OR 1.710,p= 0.010), and perineural invasion (OR 1.968,p= 0.002) were found to be risk factors affecting disease-free survival, while old diabetes (odds ratio [OS] 1.981,p= 0.003) and perineural invasion (OR 2.270,p= 0.003) were found to be risk factors affecting overall survival. Conclusions: IPMN is closely associated with early pancreatic cancer and may provide an opportunity for early detection. The presence of perineural invasion was a crucial prognostic factor for both overall and disease-free survival in patients with stage 1 pancreatic cancer.
背景：目前对早期胰腺癌的特征了解有限。本研究旨在通过分析大量1期胰腺癌患者，明确早期胰腺癌的临床特征、早期诊断线索及预后影响因素。方法：利用包含八家学术机构全部医疗记录数据库的临床数据仓库，筛选并分析2010年1月至2023年5月期间确诊的胰腺癌患者。结果：共纳入257例1期胰腺癌患者，其中男性134例（52%），平均年龄67.2±9.9岁。与1B期（肿瘤直径2-4 cm）患者相比，1A期（肿瘤直径≤2 cm）患者具有以下特征：胰体尾肿瘤比例高于胰头肿瘤（p=0.028）；新发糖尿病比例更高而既往糖尿病史比例更低（p=0.010）；黄疸发生率更低（p=0.020）；更多患者有导管内乳头状黏液性肿瘤随访史（p=0.029）；急性胰腺炎病史更常见（p=0.013）。病理结果显示，1A期患者中导管内乳头状黏液性肿瘤（p<0.001）和低级别胰腺上皮内瘤变（p=0.004）比例更高。所有13例直径小于1 cm的胰腺肿瘤均存在导管内乳头状黏液性肿瘤成分。多因素分析显示：切缘阳性（风险比[OR] 1.536，p=0.040）、静脉侵犯（OR 1.710，p=0.010）和神经侵犯（OR 1.968，p=0.002）是影响无病生存期的危险因素；而既往糖尿病史（风险比[OS] 1.981，p=0.003）和神经侵犯（OR 2.270，p=0.003）是影响总生存期的危险因素。结论：导管内乳头状黏液性肿瘤与早期胰腺癌密切相关，可能为早期诊断提供契机。神经侵犯的存在是影响1期胰腺癌患者总生存期和无病生存期的关键预后因素。
肿瘤(癌症)患者之家