Retrospective Study
Copyright ©The Author(s) 2020.
World J Gastroenterol. Dec 14, 2020; 26(46): 7382-7404
Published online Dec 14, 2020. doi: 10.3748/wjg.v26.i46.7382
Table 1 Baseline characteristics of 282 pancreatic ductal adenocarcinoma patients who underwent R0 resection, n (%)
Characteristic
Patients, n = 282
Age in yr61 (31-81)
> 60136 (48.2)
≤ 60146 (51.8)
Sex
Male151 (53.5)
Female131 (46.5)
Clinical symptoms
Absent57 (20.2)
Present225 (79.8)
Diabetes
Absent201 (71.3)
Present81 (28.7)
Smoking status
Absent215 (76.2)
Present67 (23.8)
Alcohol consumption
Absent235 (83.3)
Present47 (16.7)
Family history of cancer
Absent271 (96.1)
Present11 (3.9)
Blood type
A87 (30.9)
B93 (33.0)
AB22 (7.8)
O80 (28.4)
Tumor location
Head and neck130 (46.1)
Body and tail152 (53.9)
Approaches of open surgery
Pancreaticoduodenectomy130 (46.1)
Distal pancreatectomy with splenectomy152 (53.9)
Degree of differentiation
Well34 (12.1)
Moderately217 (77.0)
Poorly31 (11.0)
Lymphovascular invasion
Absent203 (72.0)
Present79 (28.0)
Perineural invasion
Absent70 (24.8)
Present212 (75.2)
Capsular invasion
Absent49 (17.4)
Present233 (82.6)
Maximum tumor diameter in cm
> 488 (31.2)
≤ 4194 (68.8)
T stage
T134 (12.1)
T2159 (56.4)
T389 (31.6)
Number of metastatic lymph nodes
Absent161 (57.1)
Present121 (42.9)
N stage
N0161 (57.1)
N192 (32.6)
N229 (10.3)
TNM stage
IA20 (7.1)
IB92 (32.6)
IIA49 (17.4)
IIB92 (32.6)
III29 (10.3)
Adjuvant therapy
Absent124 (44.0)
Present158 (56.0)
Preoperative CA19-9 level in U/mL172.4 (0.6-55412.0)
> 336.477 (27.3)
≤ 336.4205 (72.7)
Preoperative plasma fibrinogen concentration in g/L3.02 (1.20-6.70)
> 3.31141 (50.0)
≤ 3.31141 (50.0)
Preoperative plasma albumin level in g/L42.6 (23.2-54.0)
> 45.285 (30.1)
≤ 45.2197 (69.9)
Preoperative FAR0.07 (0.03-0.21)
> 0.08126 (44.7)
≤ 0.08156 (55.3)
Table 2 Correlation between preoperative plasma fibrinogen concentration and clinicopathological characteristics in pancreatic ductal adenocarcinoma patients who underwent R0 resection, n (%)
Characteristics
Preoperative plasma fibrinogen concentration
P value
> 3.31 g/L, n = 141
≤ 3.31 g/L, n = 141
Age in yr0.812
> 6072 (25.5)74 (26.2)
≤ 6069 (24.5)67 (23.8)
Sex0.283
Male71 (25.2)80 (28.4)
Female70 (24.8)61 (21.6)
Clinical symptoms< 0.001
Absent15 (5.3)42 (14.9)
Present126 (44.7)99 (35.1)
Diabetes0.357
Absent97 (34.4)104 (36.9)
Present44 (15.6)37 (13.1)
Smoking status0.889
Absent107 (37.9)108 (38.3)
Present34 (12.1)33 (11.7)
Alcohol consumption0.263
Absent121 (42.9)114 (40.4)
Present20 (7.1)27 (9.6)
Family history of cancer0.356
Absent137 (48.6)134 (47.5)
Present4 (1.4)7 (2.5)
Blood type0.565
A39 (13.8)48 (17.0)
B51 (18.1)42 (14.9)
AB10 (3.5)12 (4.3)
O41 (14.5)39 (13.8)
Tumor location< 0.001
Head and neck80 (28.4)50 (17.7)
Body and tail61 (21.6)91 (32.3)
Approaches of open surgery< 0.001
Pancreaticoduodenectomy80 (28.4)50 (17.7)
Distal pancreatectomy with splenectomy61 (21.6)91 (32.3)
Degree of differentiation0.079
Well20 (7.1)14 (5.0)
Moderately111 (39.4)106 (37.6)
Poorly10 (3.5)21 (7.4)
Lymphovascular invasion0.233
Absent97 (34.4)106 (37.6)
Present44 (15.6)35 (12.4)
Perineural invasion0.054
Absent28 (9.9)42 (14.9)
Present113 (40.1)99 (35.1)
Capsular invasion0.271
Absent21 (7.4)28 (9.9)
Present120 (42.6)113 (40.1)
Maximum tumor diameter in cm1.000
> 444 (15.6)44 (15.6)
≤ 497 (34.4)97 (34.4)
T stage0.991
T117 (6.0)17 (6.0)
T280 (28.4)79 (28.0)
T344 (15.6)45 (16.0)
Number of metastatic lymph nodes0.718
Absent82 (29.1)79 (28.0)
Present59 (20.9)62 (22.0)
N stage0.110
N082 (29.1)79 (28.0)
N140 (14.2)52 (18.4)
N219 (6.7)10 (3.5)
TNM stage0.099
IA8 (2.8)12 (4.3)
IB44 (15.6)48 (17.0)
IIA30 (10.6)19 (6.7)
IIB40 (14.2)52 (18.4)
III19 (6.7)10 (3.5)
Adjuvant therapy0.631
Absent64 (22.7)60 (21.3)
Present77 (27.3)81 (28.7)
Preoperative CA19-9 level in U/mL0.023
> 336.447 (16.7)30 (10.6)
≤ 336.494 (33.3)111 (39.4)
Preoperative plasma albumin level in g/L0.006
> 45.232 (11.3)53 (18.8)
≤ 45.2109 (38.2)88 (31.2)
Preoperative FAR< 0.001
> 0.08114 (40.4)12 (4.3)
≤ 0.0827 (9.6)129 (45.7)
Table 3 Correlation between preoperative plasma albumin level and clinicopathological characteristics in pancreatic ductal adenocarcinoma patients who underwent R0 resection, n (%)
Characteristics
Preoperative plasma albumin level
P value
> 45.2 g/L, n = 85
≤ 45.2 g/L, n = 197
Age in yr0.602
> 6042 (14.9)104 (36.9)
≤ 6043 (15.2)93 (33.0)
Sex0.699
Male47 (16.7)104 (36.9)
Female38 (13.5)93 (33.0)
Clinical symptoms0.012
Absent25 (8.9)32 (11.3)
Present60 (21.3)165 (58.5)
Diabetes0.458
Absent58 (20.6)143 (50.7)
Present27 (9.6)54 (19.1)
Smoking status0.806
Absent64 (22.7)151 (53.5)
Present21 (7.4)46 (16.3)
Alcohol consumption0.523
Absent69 (24.5)166 (58.9)
Present16 (5.7)31 (11.0)
Family history of cancer0.832
Absent82 (29.1)189 (67.0)
Present3 (1.1)8 (2.8)
Blood type0.169
A33 (11.7)54 (19.1)
B22 (7.8)71 (25.2)
AB8 (2.8)14 (5.0)
O22 (7.8)58 (20.6)
Tumor location< 0.001
Head and neck24 (8.5)106 (37.6)
Body and tail61 (21.6)91 (32.3)
Approaches of open surgery< 0.001
Pancreaticoduodenectomy24 (8.5)106 (37.6)
Distal pancreatectomy with splenectomy61 (21.6)91 (32.3)
Degree of differentiation0.567
Well8 (2.8)26 (9.2)
Moderately66 (23.4)151 (53.5)
Poorly11 (3.9)20 (7.1)
Lymphovascular invasion0.814
Absent62 (22.0)141 (50.0)
Present23 (8.2)56 (19.9)
Perineural invasion0.741
Absent20 (7.1)50 (17.7)
Present65 (23.0)147 (52.1)
Capsular invasion0.673
Absent16 (5.7)33 (11.7)
Present69 (24.5)164 (58.2)
Maximum tumor diameter in cm0.330
> 430 (10.6)58 (20.6)
≤ 455 (19.5)139 (49.3)
T stage0.530
T18 (2.8)26 (9.2)
T247 (16.7)112 (39.7)
T330 (10.6)59 (20.9)
Number of metastatic lymph nodes0.363
Absent52 (18.4)109 (38.7)
Present33 (11.7)88 (31.2)
N stage0.127
N052 (18.4)109 (38.7)
N129 (10.3)63 (22.3)
N24 (1.4)25 (8.9)
TNM stage0.145
IA4 (1.4)16 (5.7)
IB34 (12.1)58 (20.6)
IIA14 (5.0)35 (12.4)
IIB29 (10.3)63 (22.3)
III4 (1.4)25 (8.9)
Adjuvant therapy0.003
Absent26 (9.2)98 (34.8)
Present59 (20.9)99 (35.1)
Preoperative CA19-9 level in U/mL0.416
> 336.426 (9.2)51 (18.1)
≤ 336.459 (20.9)146 (51.8)
Preoperative plasma fibrinogen concentration in g/L0.006
> 3.3132 (11.3)109 (38.7)
≤ 3.3153 (18.8)88 (31.2)
Preoperative FAR< 0.001
> 0.0815 (5.3)111 (39.4)
≤ 0.0870 (24.8)86 (30.5)
Table 4 Correlation between preoperative fibrinogen-to-albumin ratio and clinicopathological characteristics in pancreatic ductal adenocarcinoma patients who underwent R0 resection, n (%)
Characteristic
Preoperative FAR
P value
> 0.08, n = 126
≤ 0.08, n = 156
Age in yr0.854
> 6066 (23.4)80 (28.4)
≤ 6060 (21.3)76 (27.0)
Sex0.724
Male66 (23.4)85 (30.1)
Female60 (21.3)71 (25.2)
Clinical symptoms0.001
Absent14 (5.0)43 (15.2)
Present112 (39.7)113 (40.1)
Diabetes0.831
Absent89 (31.6)112 (39.7)
Present37 (13.1)44 (15.6)
Smoking status0.765
Absent95 (33.7)120 (42.6)
Present31 (11.0)36 (12.8)
Alcohol consumption0.335
Absent108 (38.3)127 (45.0)
Present18 (6.4)29 (10.3)
Family history of cancer0.571
Absent122 (43.3)149 (52.8)
Present4 (1.4)7 (2.5)
Blood type0.817
A36 (12.8)51 (18.1)
B45 (16.0)48 (17.0)
AB10 (3.5)12 (4.3)
O35 (12.4)45 (16.0)
Tumor location< 0.001
Head and neck77 (27.3)53 (18.8)
Body and tail49 (17.4)103 (36.5)
Approaches of open surgery< 0.001
Pancreaticoduodenectomy77 (27.3)53 (18.8)
Distal pancreatectomy with splenectomy49 (17.4)103 (36.5)
Degree of differentiation0.208
Well20 (7.1)14 (5.0)
Moderately93 (33.0)124 (44.0)
Poorly13 (4.6)18 (6.4)
Lymphovascular invasion0.729
Absent92 (32.6)111 (39.4)
Present34 (12.1)45 (16.0)
Perineural invasion0.082
Absent25 (8.9)45 (16.0)
Present101 (35.8)111 (39.4)
Capsular invasion0.360
Absent19 (6.7)30 (10.6)
Present107 (37.9)126 (44.7)
Maximum tumor diameter in cm0.391
> 436 (12.8)52 (18.4)
≤ 490 (31.9)104 (36.9)
T stage0.462
T113 (4.6)21 (7.4)
T276 (27.0)83 (29.4)
T337 (13.1)52 (18.4)
Number of metastatic lymph nodes0.988
Absent72 (25.5)89 (31.6)
Present54 (19.1)67 (23.8)
N stage0.902
N072 (25.5)89 (31.6)
N140 (14.2)52 (18.4)
N214 (5.0)15 (5.3)
TNM stage0.494
IA6 (2.1)14 (5.0)
IB40 (14.2)52 (18.4)
IIA26 (9.2)23 (8.2)
IIB40 (14.2)52 (18.4)
III14 (5.0)15 (5.3)
Adjuvant therapy0.531
Absent58 (20.6)66 (23.4)
Present68 (24.1)90 (31.9)
Preoperative CA19-9 level in U/mL0.132
> 336.440 (14.2)37 (13.1)
≤ 336.486 (30.5)119 (42.2)
Preoperative plasma fibrinogen concentration in g/L< 0.001
> 3.31114 (40.4)27 (9.6)
≤ 3.3112 (4.3)129 (45.7)
Preoperative plasma albumin level in g/L< 0.001
> 45.215 (5.3)70 (24.8)
≤ 45.2111 (39.4)86 (30.5)
Table 5 Univariate analysis for overall survival in pancreatic ductal adenocarcinoma patients who underwent R0 resection
Characteristic
HR (95%CI)
P value
Age in yr1.358 (1.036-1.780)0.027
> 60
≤ 60
Sex1.281 (0.979-1.675)0.071
Male
Female
Clinical symptoms0.600 (0.424-0.848)0.004
Absent
Present
Diabetes0.903 (0.676-1.206)0.491
Absent
Present
Smoking status0.866 (0.635-1.181)0.363
Absent
Present
Alcohol consumption1.083 (0.754-1.556)0.667
Absent
Present
Family history of cancer1.251 (0.617-2.537)0.535
Absent
Present
Blood type0.579
A
B
AB
O
Tumor location0.954 (0.729-1.249)0.731
Head and neck
Body and tail
Approaches of open surgery0.954 (0.729-1.249)0.731
Pancreaticoduodenectomy
Distal pancreatectomy with splenectomy
Degree of differentiation< 0.001
Well
Moderately
Poorly
Lymphovascular invasion0.793 (0.590-1.065)0.123
Absent
Present
Perineural invasion0.905 (0.666-1.231)0.525
Absent
Present
Capsular invasion0.609 (0.420-0.885)0.009
Absent
Present
Maximum tumor diameter in cm1.403 (1.058-1.862)0.019
> 4
≤ 4
T stage0.035
T1
T2
T3
Number of metastatic lymph nodes0.590 (0.449-0.775)< 0.001
Absent
Present
N stage0.001
N0
N1
N2
TNM stage0.003
IA
IB
IIA
IIB
III
Adjuvant therapy1.625 (1.244-2.123)< 0.001
Absent
Present
Preoperative CA19-9 level in U/mL1.971 (1.469-2.644)< 0.001
> 336.4
≤ 336.4
Preoperative plasma fibrinogen concentration in g/L1.888 (1.438-2.479)< 0.001
> 3.31
≤ 3.31
Preoperative plasma albumin level in g/L0.650 (0.475-0.890)0.007
> 45.2
≤ 45.2
Preoperative FAR2.257 (1.725-2.952)< 0.001
> 0.08
≤ 0.08
Table 6 Multivariate analysis for overall survival in pancreatic ductal adenocarcinoma patients who underwent R0 resection
Characteristics
HR (95%CI)
Wald
P value
Age in yr1.289 (0.971-1.710)3.0760.079
> 60
≤ 60
Degree of differentiation31.261< 0.001
Poorly/well5.209 (2.837-9.562)28.353< 0.001
Moderately/well1.912 (1.184-3.085)7.0370.008
Capsular invasion0.697 (0.475-1.022)3.4090.065
Absent
Present
Maximum tumor diameter in cm1.296 (0.959-1.751)2.8430.092
> 4
≤ 4
Number of metastatic lymph nodes0.678 (0.509-0.904)7,0270.008
Absent
Present
Adjuvant therapy1.604 (1.214-2.118)11.0580.001
Absent
Present
Preoperative CA19-9 level in U/mL1.740 (1.288-2.352)13.003< 0.001
> 336.4
≤ 336.4
Preoperative FAR2.258 (1.720-2.963)34.468< 0.001
> 0.08
≤ 0.08