Treatment options in patients with pancreatic cancer: A 10-year multicenter epidemiological investigation in China

Table 1 Distribution of basic demographic characteristics

Characteristic		Case	%
Age at first diagnosis, year
	< 55	549	30.90
	55-64	601	33.80
	65-74	444	25.0
	≥ 75	181	10.10
Sex
	Male	2037	62.56
	Female	1217	37.38
BMI
	< 18.5	197	16.54
	18.5-23.9	721	60.54
	> 23.9	273	22.92
History of pancreatitis
	No	2706	95.90
	Yes	114	4.10
History of intestinal flora disorders
	No	2428	96.30
	Yes	93	3.70
Family history of pancreatic malignancy
	No	2689	98.57
	Yes	39	1.43
Diabetes mellitus
	No	2601	84.50
	Yes	477	15.50
Smoking
	Never	2163	70.18
	Ever	364	11.81
	Now	555	18.01
Alcohol drinking
	Never	2314	75.25
	Ever	296	9.62
	Now	465	15.12
Staging of pancreatic cancer
	Ⅰ	373	15.70
	Ⅱ	358	15.00
	Ⅲ	295	12.40
	Ⅳ	1354	56.90
Differentiation degree
	Well	160	15.14
	Moderately	431	40.78
	Poorly	466	44.09
Surgery
	Yes	2134	66.80
	No	1063	33.20
Surgical margin
	Negative	673	80.00
	Positive	169	20.00
No. of lymph node metastasis
	0	941	73.60
	1-3	270	21.10
	> 3	68	5.30
Chemotherapy
	Yes	1076	39.73
	No	1632	60.26
Ki-67
	Not done	1130	84.90
	Positive	193	14.50
	Negative	8	0.60
CK or AE1/AE3
	Not done	1228	85.81
	Positive	191	13.35
	Negative	12	0.84

BMI: Body mass index; CK: Cytokeratin.

Table 2 Treatments options for patients with pancreatic cancer in China from 2005 to 2014

Treatment modalities		Cases	%
Surgery
Mode of operation
	Radical	1059	49.67
	Palliative	576	27.02
	Other	497	23.31
Mode of execution
	Traditional open surgery	2073	91.85
	Laparoscopic surgery	63	2.79
	Robotic surgery	3	0.13
	Other	118	5.23
Chemotherapy
	Neoadjuvant	90	8.36
	Adjuvant therapy	382	35.50
	Relapse/metastasis treatment	604	56.13
Targeted therapy information
	Neoadjuvant	2	2.60
	Adjuvant therapy	39	51.30
	Relapsing metastasis therapy	35	46.00
Radiation therapy information
	Concurrent	36	16.82
	Postoperative adjuvant	75	35.05
	Palliative	137	64.02
	Intraoperative	83	38.79
	Other	31	14.49

Drug statistics of chemotherapy include single drug and combination drug.

Table 3 Analysis of risk factors affecting the prognosis of pancreatic cancer

	Univariate Cox regression		Multivariate Cox regression
	HR (95%CI)	P value	HR (95%CI)	P value
Age, year
< 55	Reference		Reference
55-64	1.37 (1.08-1.76)	0.010	1.80 (1.29-2.50)	0.041
65-74	1.58 (1.22-2.05)	< 0.001	1.45 (1.03-2.04)	0.018
≥ 75	3.19 (2.34-4.34)	< 0.001	2.68 (1.67-4.32)	0.007
Sex
Male	Reference		Reference
Female	0.95 (0.78-1.16)	0.622	0.88 (0.65-1.18)	0.531
BMI
< 18.5	1.60 (1.23-2.07)	0.0003	2.13 (1.36-3.33)	0.002
(18.5-24)	Reference		Reference
(24-28)	0.75 (0.55-1.02)	0.062	0.97 (0.60-1.59)	0.394
≥ 28	0.75 (0.41-1.38)	0.355	0.28 (0.07-1.16)	0.697
History of pancreatitis
No	Reference		Reference
Yes	1.28 (0.76-2.14)	0.349	2.07 (1.02-4.19)	0.043
History of intestinal flora disorders
No	Reference		Reference
Yes	1.03 (0.63-1.67)	0.919	0.93 (0.54-1.61)	0.428
Family history of pancreatic malignancy
No	Reference		Reference
Yes	0.39 (0.10-1.57)	0.185	0.33 (0.14-1.35)	0.371
Smoking
Never	Reference		Reference
Ever	0.75 (0.54-1.05)	0.094	0.60 (0.35-1.04)	0.420
Now	0.97 (0.75-1.25)	0.818	0.88 (0.59-1.34)	0.782
Alcohol consumption
Never	Reference		Reference
Ever	1.00 (0.72-1.38)	0.993	1.10 (0.63-1.91)	0.346
Now	0.81 (0.60-1.09)	0.168	1.50 (0.91-2.46)	0.436
Diabetes mellitus
No	Reference		Reference
Yes	0.89 (0.68-1.18)	0.427	1.13 (0.77-1.66)	0.376
Staging of pancreatic cancer
Ⅰ	Reference		Reference
Ⅱ	1.48 (0.93-2.36)	0.099	1.72 (0.77-3.80)	0.183
Ⅲ	2.32 (1.49-3.62)	< 0.001	2.76 (1.02-7.44)	0.045
Ⅳ	2.12 (1.43-3.14)	0.001	2.03 (0.90-4.56)	0.085
Differentiation degree
Well	Reference		Reference
Moderately	0.91 (0.51-1.63)	0.757	0.98 (0.41-2.32)	0.964
Poorly	2.00 (1.15-3.45)	0.014	1.35 (0.58-3.13)	0.480
Surgery
No	Reference		Reference
Yes	0.57 (0.47-0.69)	< 0.001	0.48 (0.36-0.64)	0.036
Surgical margin
Positive	Reference		Reference
Negative	0.48 (0.33-0.69)	< 0.001	0.60 (0.24-0.99)	0.033
No. of lymph node metastasis
0	Reference		Reference
1-3	1.12 (0.84-1.49)	0.441	1.02 (0.56-1.87)	0.939
> 3	0.82 (0.46-1.46)	0.496	4.32 (1.01-18.52)	0.007
Chemotherapy
No	Reference		Reference
Yes	0.59 (0.48-0.71)	< 0.001	0.35 (0.21-0.60)	< 0.001
Ki-67
Negative	Reference		--
Positive	3.43 (0.45-26.31)	0.235	--
CK or AE1/AE3
Negative	Reference		--
Positive	6.39 (0.8-51.00)	0.080	--

Bold values indicated P < 0.05, which was statistically significant. Ki-67 and CK or AE1/AE3 were not included in multivariate Cox regression due to the small number of tested people. For the variables with P < 0.1 in the univariate analysis, we considered them to be factors that might affect the prognosis of pancreatic cancer and included them in the multivariate analysis. However, although other items had P > 0.01, they are still relevant risk factors suggested by previous studies, such as the history of pancreatitis and the history of intestinal flora disorders; therefore, these variables were included in the multivariate model. BMI: Body mass index; CI: Confidence interval; CK: Cytokeratin; HR: Hazard ratio.

Table 4 Comparison of efficacy of different chemotherapy regimens

Adjuvant therapy (case number)		P value	HR (95%CI)	Relapse/metastasis treatment (case number)		P value	HR (95%CI)
1. Fluorouracil1	Monotherapy (15)		1.00	1. First-line	Gemcitabine monotherapy (40)		1.00
	Combination (73)	0.163	0.40 (0. 11-1.44)		Tegafur + gemcitabine + platinum (2)	0.343	0.38 (0.05-2.82)
2. Gemcitabine	Monotherapy (27)		1.00		Tegafur + monotherapy (9)	0.008	0.20 (0.06-0.66)
	Combination (80)	0.019	0.40 (0.18-0.86)		Gemcitabine + albumin-bound paclitaxel (20)	0.929	0.97 (0.54-1.76)
3. All regimens	Gemcitabine monotherapy (27)		1.00		Gemcitabine + cisplatin (18)	0.015	0.16 (0.04-0.70)
	Fluorouracil monotherapy (14)	0.720	0.79 (0.22-2.89)		Gemcitabine + oxaliplatin (53)	0.788	0.94 (0.58-1.52)
	Gemcitabine + fluorouracil (38)	0.028	0.35 (0.14-0.89)		Gemcitabine + 5-FU (15)	0.577	0.80 (0.37-1.74)
	Gemcitabine + platinum (39)	0.998	0.48 (0.20-1.19)		Gemcitabine + capecitabine (21)	0.912	0.97 (0.54-1.74)
	Gemcitabine + fluorouracil + platinum2 (6)	0.113	0.19 (0.02-1.51)		Tegafur + gemcitabine + platinum (12)	0.033	0.32 (0.11-0.91)
	Fluorouracil + platinum (21)	0.117	0.29 (0.08-1.06)		FOLFIRINOX (8)	0.854	0.93 (0.42-2.07)
4. Gemcitabine-based regimens	Monotherapy (27)		1.0	2. Second-line	Tegafur monotherapy (6)		1.00
	Gemcitabine + fluorouracil (38)	0.030	0.35(0.14-0.90)		Tegafur + oxaliplatin (9)	0.278	0.49 (0.14-1.76)
	Gemcitabine + platinum (39)	0.113	0.48 (0.20-1.19)		Gemcitabine + albumin-bound paclitaxel (2)	0.343	0.35 (0.04-3.08)
	Gemcitabine + fluorouracil + platinum (6)	0.124	0.20 (0.02-1.56)		Gemcitabine + oxaliplatin (3)	0.825	1.28 (0.14-11.52)
5. Fluorouracil-based regimens	Monotherapy (14)		1.00		FOLFIRINOX (5)	0.099	0.10 (0.01-1.27)
	Gemcitabine + fluorouracil (38)	0.219	0.43 (0.11-1.65)		Oxaliplatin + 5-FU + catarabine (6)	0.943	1.05 (0.31-3.56)
	Gemcitabine + fluorouracil + platinum (6)	0.212	0.24 (0.02-2.28)		Oxaliplatin + catarabine (6)	0.892	1.10 (0.29-4.16)
	Fluorouracil + platinum (21)	0.217	0.36 (0.07-1.82)

¹Fluorouracil includes tegafur, 5-FU, and capecitabine therapies.

²Platinum includes cis-platinum and oxaliplatin.

Bold values indicated P < 0.05, which was statistically significant. The confounding factors identified in Table 2 were controlled, including age, body mass index, and history of pancreatitis. The treatment options and patient stages were not controlled because the stages and choices of patients were differentiated through different chemotherapy stages. CI: Confidence interval; HR: Hazard ratio.