Recurrence and survival after surgery for pancreatic cancer with or without acute pancreatitis

Table 1 Patient characteristics

Parameters	AP (n = 21)	No AP (n = 198)	P value
Age (yr), mean ± SD	55.6 ± 16.4	61.2 ± 10.5	0.137
Male, n (%)	13 (61.9)	128 (64.6)	0.803
Cause of acute pancreatitis n (%)
ERCP	5 (23.8)
Alcoholic	9 (42.9)
Unknown	8 (33.3)
Time to surgery (d), mean ± SD	41.4 ± 10.7	10.8 ± 5.8	< 0.001
Tumor site, (head) n (%)	14 (66.7)	149 (75.3)	0.391
Positive lymph nodes, n (%)	9 (42.9)	82 (41.4)	0.898
TNM Stage, n (%)			1.000
I	2 (9.5)	18 (9.1)
II	19 (90.5)	180 (90.9)
Surgical margin (R1), n (%)	2 (9.5)	13 (6.6)	0.955
Perineural invasion, n (%)	5 (23.8)	65 (32.8)	0.399
Vascular invasion, n (%)	2 (9.5)	20 (10.1)	1.000
Differentiation, n (%)			0.283
Well	0 (0.0)	12 (6.1)
Moderate	16 (76.2)	145 (73.2)
Poor	5 (23.8)	41 (20.7)
Medical complications n (%)	7 (33.3)	59 (29.8)	0.737
Pancreatic fstula n (%)
biochemical leak	3 (14.3)	10 (5.1)	0.223
Grade B/C	3 (14.3)	9 (4.5)	0.174
Grade B	2 (9.5)	7 (3.5)	0.461
Grade C	1 (4.8)	2 (1.0)	0.675
Adjuvant Chemotherapy, n (%)	7 (33.3)	49 (24.7)	0.391
Early recurrence, n (%)	15/21 (71.4)	68/165 (41.2)	0.009
DFS, median (95%CI)	8.4 (6.7-10.1)	14.6 (10.7-18.5)	0.007
OS, median (95%CI)	14.9 (12.5-17.3)	22.3 (17.9-26.7)	< 0.001

TNM: Tumor node metastasis; DFS: Disease-free survival; OS: Overall survival; AP: Acute pancreatitis; SD: Standard deviation; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Predictive factors of postoperative early recurrence (within 12 mo)

Parameters	P value	Univariate OR (95%CI)	Multivariate OR (95%CI)	P value
Acute pancreatitis, (yes vs no)	0.012	3.57 (1.32-9.66)	4.13 (1.41-12.10)	0.010
Adjuvant chemotherapy, (yes vs no)	0.027	0.46 (0.24-0.92)	0.42 (0.20-0.90)	0.025
Positive lymph nodes, (yes vs no)	0.001	2.74 (1.49-5.04)	3.02 (1.54-5.90)	0.001
Surgical margin, (R1 vs R0)	0.015	5.09 (1.37-18.91)	4.78 (1.16-19.74)	0.030
Vascular invasion, (yes vs no)	0.093	2.32 (0.87-6.18)		0.463
Tumor site, (distal vs head)	0.036	1.96 (1.05-3.65)	2.70 (1.33-5.47)	0.006
TNM (II/III vs I)	0.038	3.37 (1.07-10.57)		0.188

Patient characteristics and pathologic feature, including age, sex, differentiation, and prineural invasion were analyzed as well, and the differences did not reach statistical significance in these factors (data not shown). TNM: Tumor node metastasis; OR: Odd ratio; CI: Confidence interval.

Table 3 Cox regression analysis for disease-free survival

Parameters	Univariate RR (95%CI)	P value	Multivariate RR(95%CI)	P value
Acute pancreatitis, (yes vs no)	2.00 (1.19-3.36)	0.009	2.24 (1.31-3.85)	0.003
Chemotherapy, (yes vs no)	0.47 (0.31-0.72)	< 0.001	0.45 (0.29-0.70)	< 0.001
Positive lymph nodes, (yes vs no)	2.02 (1.40-2.91)	< 0.001	2.10 (1.41-3.14)	< 0.001
Vascular invasion, (yes vs no)	1.72(1.00-2.97)	0.051		0.063
Surgical margin, (R1 vs R0)	3.00(1.68-5.35)	< 0.001	2.55 (1.40-4.64)	0.002
Differentiation		0.016		0.019
Moderate vs Well	7.81 (1.92-31.84)	0.004	5.84 (1.42-24.01)	0.014
Poor vs Well	7.13 (1.67-30.38)	0.008	7.84 (1.82-33.74)	0.006
T stage, (T1/T2 vs T3/T4)	0.76 (0.47-1.22)	0.254		0.832
Perineural invasion, (yes vs no)	1.53 (1.07-2.19)	0.020		0.454
TNM stage, (II/III vs I)	2.25 (1.21-4.21)	0.011		0.516
tumor site, (distal vs head)	1.45 (1.00-2.11)	0.051	1.74 (1.15-2.64)	0.009
Age, (< 65 yr vs ≥ 65 yr)	0.82 (0.57-1.16)	0.261		0.404
Sex, (male vs female)	1.07 (0.74-1.55)	0.732		0.951

TNM: Tumor node metastasis; RR: Relative risk; CI: Confidence interval.

Table 4 Overall survival for the entire patient cohort

Parameters	Univariate RR (95%CI)	P value	Multivariate RR (95%CI)	P value
Acute pancreatitis (yes vs no)	2.47 (1.55-3.96)	< 0.001	2.35 (1.45-3.83)	0.001
Chemotherapy, (yes vs no)	0.63 (0.43-0.94)	0.024	0.52 (0.34-0.79)	0.002
Differentiation		0.002		< 0.001
Moderate vs Well	4.65 (1.47-14.72)	0.009	3.07 (0.96-9.84)	0.059
Poor vs Well	7.25 (2.21-23.74)	0.001	6.70 (2.02-22.17)	0.002
T stage, T12 vs T34	0.51 (0.27-0.98)	0.043		0.781
Positive lymph nodes, (yes vs no)	2.32 (1.64-3.29)	< 0.001	2.68 (1.83-3.92)	< 0.001
Perineural invasion, (yes vs no)	1.10 (0.77-1.57)	0.611		0.667
Vascular invasion, (yes vs no)	1.44 (0.86-2.39)	0.164		0.430
Surgical margin, (R1 vs R0)	1.41 (0.69-2.89)	0.346		0.728
TNM stage, (II/III vs I)	2.35 (1.15-4.82)	0.0		0.378
Sex, (male vs female)	1.15 (0.81-1.62)	0.443		0.568
Age (< 65 yr vs ≥ 65 yr )	0.96 (0.69-1.34)	0.803		0.694
tumor site, (distal vs head)	1.52 (1.03-2.24)	0.035	1.90 (1.24-2.90)	0.003

TNM: Tumor node metastasis; RR: Relative risk; CI: Confidence interval.