Metabolic syndrome worsens perioperative and oncological outcomes in patients with pancreatic ductal adenocarcinoma after R0 resection: A multicenter propensity score-matched study.
Source: PubMed, NCBI / U.S. National Library of Medicine
Metabolic syndrome (MS) influences the development of pancreatic ductal adenocarcinoma (PDAC), but its effect on oncological outcomes remains unclear. This study aimed to investigate the role of MS in the patients' perioperative and long-term oncological outcomes. Patients undergoing R0 resection of PDAC in seven centers from June 2015 to May 2022 were included. A propensity score matching (PSM) was performed to eliminate confounders between the groups. Perioperative outcomes of patients with and without MS were compared. Additionally, the prognosis was analyzed separately for the MS subgroup and the tumor site subgroup. Of 1548 patients, 388 (25.1%) had MS. After PSM, 1071 patients were enrolled in a 1:2 ratio. Compared with non-MS patients, MS patients had significantly higher rates of major complications, including grade B/C delayed gastric emptying and grade B/C postoperative pancreatic fistula, 90-day readmission, 90-day mortality (all P < 0.05), worse overall survival (OS) (22.7 vs. 31.5 months, P < 0.001) and recurrence-free survival (RFS) (11.9 vs. 15.8 months, P < 0.001). Multivariate analysis revealed that MS, carbohydrate antigen 19-9 > 37 U/mL, lymphatic metastasis, and major complications were independent risk factors for OS and RFS. In the subgroup analysis, patients in the high-risk MS group (4 or 5 components) showed shorter OS (20.6 vs. 23.8 months, P < 0.05) and RFS (11.1 vs. 12.6 months, P < 0.05) than patients in the low-risk MS group (3 components). Combi
Abstract
Metabolic syndrome (MS) influences the development of pancreatic ductal adenocarcinoma (PDAC), but its effect on oncological outcomes remains unclear. This study aimed to investigate the role of MS in the patients' perioperative and long-term oncological outcomes. Patients undergoing R0 resection of PDAC in seven centers from June 2015 to May 2022 were included. A propensity score matching (PSM) was performed to eliminate confounders between the groups. Perioperative outcomes of patients with and without MS were compared. Additionally, the prognosis was analyzed separately for the MS subgroup and the tumor site subgroup. Of 1548 patients, 388 (25.1%) had MS. After PSM, 1071 patients were enrolled in a 1:2 ratio. Compared with non-MS patients, MS patients had significantly higher rates of major complications, including grade B/C delayed gastric emptying and grade B/C postoperative pancreatic fistula, 90-day readmission, 90-day mortality (all P < 0.05), worse overall survival (OS) (22.7 vs. 31.5 months, P < 0.001) and recurrence-free survival (RFS) (11.9 vs. 15.8 months, P < 0.001). Multivariate analysis revealed that MS, carbohydrate antigen 19-9 > 37 U/mL, lymphatic metastasis, and major complications were independent risk factors for OS and RFS. In the subgroup analysis, patients in the high-risk MS group (4 or 5 components) showed shorter OS (20.6 vs. 23.8 months, P < 0.05) and RFS (11.1 vs. 12.6 months, P < 0.05) than patients in the low-risk MS group (3 components). Combined diabetes mellitus, obesity, and dyslipidemia in PDAC patients yielded the poorest OS and RFS outcomes following R0 resection. Perioperative and oncological prognosis was significantly worse in PDAC patients with MS after R0 resection. Patients experienced worse long-term survival outcomes with the increase in the number of MS components. PDAC patients with diabetes mellitus, obesity, and dyslipidemia should undergo closer follow-up monitoring after R0 resection.