Journal of Surgery Concepts & Practice ›› 2025, Vol. 30 ›› Issue (05): 428-437.doi: 10.16139/j.1007-9610.2025.05.09
• Original article • Previous Articles Next Articles
WANG Yu, HU Kaixin, ZHAO Fengqing, LI Huangbao(
)
Received:2025-02-19
Online:2025-09-25
Published:2025-12-09
Contact:
LI Huangbao
E-mail:lhb641834@163.com
CLC Number:
WANG Yu, HU Kaixin, ZHAO Fengqing, LI Huangbao. Efficacy variations of adjuvant chemotherapy across disease stages in duodenal adenocarcinoma: a multivariate survival analysis based on the SEER database[J]. Journal of Surgery Concepts & Practice, 2025, 30(05): 428-437.
Tab 1
Baseline demographic and clinical characteristics of patients with DAC undergoing surgery before propensity score matching [n(%)]
| Variables | AC group （n=620） | Other group （n=575） | Total （n=1195） | χ² value | P value |
|---|---|---|---|---|---|
| Sex | 0.42 | 0.812 | |||
| Male | 349 (56.3) | 313 (54.4) | 662 (55.4) | ||
| Female | 271 (43.7) | 262 (45.6) | 533 (44.6) | ||
| Age (year) | 70.06 | < 0.001 | |||
| <65 | 342 (55.2) | 179 (31.1) | 521 (43.6) | ||
| ≥65 | 278 (44.8) | 396 (68.9) | 674 (56.4) | ||
| Race | 2.62 | 0.623 | |||
| White | 452 (72.9) | 442 (76.9) | 894 (74.8) | ||
| Black | 107 (17.3) | 82 (14.3) | 189 (15.8) | ||
| Others | 61 (9.8) | 51 (8.9) | 112 (9.4) | ||
| Tumor size (mm) | 3.36 | 0.187 | |||
| <40 | 282 (45.5) | 292 (50.8) | 574 (48.0) | ||
| ≥40 | 338 (54.5) | 283 (49.2) | 621 (52.0) | ||
| Year of diagnosis | 4.42 | 0.110 | |||
| 2000—2012 | 259 (41.8) | 275 (47.8) | 534 (44.7) | ||
| 2013—2021 | 361 (58.2) | 300 (52.2) | 661 (55.3) | ||
| Grade | 10.05 | 0.007 | |||
| Poorly (Ⅲ+ Ⅳ) | 260 (41.9) | 190 (33.0) | 450 (37.7) | ||
| Well (I +Ⅱ) | 360 (58.1) | 385 (67.0) | 745 (62.3) | ||
| Radiotherapy | 130.2 | < 0.001 | |||
| Others | 479 (77.3) | 569 (99.0) | 1048 (87.7) | ||
| Present | 141 (22.7) | 6 (1.0) | 147 (12.3) | ||
| RNE | 11.31 | 0.003 | |||
| ≤18 | 362 (58.4) | 390 (67.8) | 752 (62.9) | ||
| >18 | 258 (41.6) | 185 (32.2) | 443 (37.1) | ||
| N stage | 121.19 | < 0.001 | |||
| N0 | 148 (23.9) | 315 (54.8) | 463 (38.7) | ||
| N1 | 200 (32.2) | 121 (21.0) | 321 (26.9) | ||
| N2 | 272 (43.9) | 139 (24.2) | 411 (34.4) | ||
| TNM stage | 159.2 | < 0.001 | |||
| Ⅰ | 10 (1.6) | 98 (17.0) | 108 (9.0) | ||
| ⅡA | 65 (10.5) | 138 (24.0) | 203 (17.0) | ||
| ⅡB | 73 (11.8) | 79 (13.7) | 152 (12.7) | ||
| ⅢA | 200 (32.3) | 121 (21.0) | 321 (26.9) | ||
| ⅢB | 272 (43.9) | 139 (24.2) | 411 (34.4) |
Tab 2
Baseline demographic and clinical characteristics of patients with DAC undergoing surgery after propensity score matching [n(%)]
| Variables | AC group （n=317） | Other group （n=317） | Total （n=634） | χ² value | P value |
|---|---|---|---|---|---|
| Sex | 0.23 | 0.889 | |||
| Male | 184 (58.0) | 190 (59.9) | 374 (59.0) | ||
| Female | 133 (42.0) | 127 (40.1) | 260 (41.0) | ||
| Age (year) | 1.66 | 0.436 | |||
| <65 | 141 (44.5) | 125 (39.4) | 266 (42.0) | ||
| ≥65 | 176 (55.5) | 192 (60.6) | 368 (58.0) | ||
| Race | 0.07 | 0.999 | |||
| White | 238 (75.1) | 236 (74.4) | 474 (74.8) | ||
| Black | 48 (15.1) | 48 (15.1) | 96 (15.1) | ||
| Others | 31 (9.8) | 33 (10.4) | 64 (10.1) | ||
| Tumor size (mm) | 0.01 | 0.997 | |||
| <40 | 146 (46.1) | 147 (46.4) | 293 (46.2) | ||
| ≥40 | 171 (53.9) | 170 (53.6) | 341 (53.8) | ||
| Year of diagnosis | 0.78 | 0.677 | |||
| 2000—2012 | 140 (44.2) | 129 (40.7) | 269 (42.4) | ||
| 2013—2021 | 177 (55.8) | 188 (59.3) | 365 (57.6) | ||
| Grade | 5.23 | 0.07 | |||
| Poorly (Ⅲ+ Ⅳ) | 132 (41.6) | 104 (32.8) | 236 (37.2) | ||
| Well (I +Ⅱ) | 185 (58.4) | 213 (67.2) | 398 (62.8) | ||
| Radiotherapy | 1.51 | 0.47 | |||
| Others | 306 (96.5) | 311 (98.1) | 617 (97.3) | ||
| Present | 11 (3.5) | 6 (1.9) | 17 (2.7) | ||
| RNE | 0.54 | 0.763 | |||
| ≤18 | 191 (60.3) | 200 (63.1) | 391 (61.7) | ||
| >18 | 126 (39.7) | 117 (36.9) | 243 (38.3) | ||
| N stage | 0.07 | 0.999 | |||
| N0 | 101 (31.9) | 98 (30.9) | 199 (31.4) | ||
| N1 | 102 (32.2) | 103 (32.5) | 205 (32.3) | ||
| N2 | 114 (36.0) | 116 (36.6) | 230 (36.3) | ||
| TNM stage | 0.27 | 1 | |||
| Ⅰ | 9 (2.8) | 10 (3.2) | 19 (3.0) | ||
| ⅡA | 50 (15.8) | 50 (15.8) | 100 (15.8) | ||
| ⅡB | 42 (13.2) | 38 (12.0) | 80 (12.6) | ||
| ⅢA | 102 (32.2) | 103 (32.5) | 205 (32.3) | ||
| ⅢB | 114 (36.0) | 116 (36.6) | 230 (36.3) |
Fig 1
CSS curves for DAC after surgery A: All stages; B: StageⅠ; C: StageⅡA; D: StageⅡB; E: StageⅢA; F: Stage ⅢB.
Fig 2
OS curves for DAC after surgery A: All stages; B: StageⅠ; C: StageⅡA; D: StageⅡB; E: StageⅢA; F: Stage ⅢB.
Tab 3
Median CSS time and 1-year, 3-year, and 5-year survival rates for each stage
| Stage | Group | Median time（month） | 1-year survival rate （%） | 3-year survival rate （%） | 5-year survival rate （%） |
|---|---|---|---|---|---|
| All | Other group | 29 | 67.2 | 47. 2 | 39.4 |
| AC group | 64 | 90.3 | 63.3 | 50.1 | |
| Ⅰ | Other group | 71 | 100 | 75.0 | 75.0 |
| AC group | - | 100 | 80.0 | 80.0 | |
| ⅡA | Other group | - | 91.3 | 83.2 | 72.6 |
| AC group | - | 95.5 | 88.1 | 83.4 | |
| ⅡB | Other group | - | 79.0 | 64.8 | 64.8 |
| AC group | - | 91.6 | 64.3 | 52.4 | |
| ⅢA | Other group | 28 | 66.0 | 46.6 | 34.1 |
| AC group | 55 | 94.6 | 67.5 | 47.3 | |
| ⅢB | Other group | 13 | 50.4 | 22.9 | 18.4 |
| AC group | 33 | 83.2 | 48.5 | 37.6 |
Tab 4
Median OS time and 1-year, 3-year, and 5-year survival rates for each stage
| Stage | Group | Median time（month） | 1-year survival rate （%） | 3-year survival rate （%） | 5-year survival rate （%） |
|---|---|---|---|---|---|
| All | Other group | 23 | 61.9 | 39.3 | 31.1 |
| AC group | 54 | 89.1 | 61.4 | 48.2 | |
| Ⅰ | Other group | 71 | 100 | 60.0 | 60.0 |
| AC group | - | 88.9 | 71.1 | 53.3 | |
| ⅡA | Other group | - | 87.1 | 76.9 | 63.2 |
| AC group | - | 95.5 | 88.1 | 83.4 | |
| ⅡB | Other group | 34 | 72.4 | 48.9 | 43.5 |
| AC group | 108 | 89.0 | 62.5 | 50.9 | |
| ⅢA | Other group | 23 | 60.6 | 39.1 | 27.2 |
| AC group | 55 | 93.7 | 66.8 | 46.9 | |
| ⅢB | Other group | 10 | 45.3 | 18.4 | 14.7 |
| AC group | 30 | 82.4 | 45.4 | 35.2 |
Tab 5
Univariate and multivariate COX analyses of CSS in patients with DAC undergoing surgery
| Variables | Cases | Univariate COX for CSS | Multivariate COX for CSS | |||
|---|---|---|---|---|---|---|
| HR(95%CI) | P value | HR(95%CI) | P value | |||
| Sex | ||||||
| Male | 374 | reference | ||||
| Female | 260 | 0.83(0.66-1.05) | 0.130 | |||
| Age (year) | ||||||
| <65 | 266 | reference | reference | |||
| ≥65 | 368 | 1.7(1.33-2.17) | <0.001 | 1.34 (1.04-1.73) | 0.022 | |
| Race | ||||||
| White | 474 | reference | ||||
| Black | 96 | 1.21(0.88-1.67) | 0.241 | |||
| Others | 64 | 1.14(0.77-1.69) | 0.518 | |||
| Tumor size (mm) | ||||||
| <40 | 293 | reference | reference | |||
| ≥40 | 341 | 0.76(0.6-0.96) | 0.0212 | 0.84 (0.67-1.07) | 0.159 | |
| Year of diagnosis | ||||||
| 2000—2012 | 269 | reference | reference | |||
| 2013—2021 | 365 | 0.71(0.56-0.9) | 0.005 | 0.79 (0.62-0.99) | 0.044 | |
| Grade | ||||||
| Well (Ⅰ+Ⅱ) | 398 | reference | reference | |||
| Poorly (Ⅲ+Ⅳ) | 236 | 1.5(1.19-1.89) | <0.001 | 1.51 (1.19-1.92) | 0.001 | |
| Radiotherapy | ||||||
| Others | 617 | reference | ||||
| Present | 17 | 0.48(0.22-1.09) | 0.0474 | |||
| RNE | ||||||
| ≤18 | 391 | reference | reference | |||
| >18 | 243 | 0.64(0.5-0.83) | <0.001 | 0.61 (0.47-0.79) | <0.001 | |
| N stage | ||||||
| N0 | 199 | reference | ||||
| N1 | 205 | 2.39(1.69-3.38) | <0.001 | |||
| N2 | 230 | 3.73(2.68-5.2) | <0.001 | |||
| TNM stage | ||||||
| Ⅰ | 19 | reference | reference | |||
| ⅡA | 100 | 0.9(0.26-3.05) | <0.001 | 1.07 (0.32-3.66) | 0.909 | |
| ⅡB | 80 | 1.96(0.59-6.49) | <0.001 | 2.08 (0.63-6.89) | 0.23 | |
| ⅢA | 205 | 3.1(0.98-9.78) | <0.001 | 3.34 (1.05-10.55) | 0.04 | |
| ⅢB | 230 | 4.84(1.54-15.2) | <0.001 | 5.31 (1.69-16.7) | 0.004 | |
| Chemotherapy | ||||||
| Other | 317 | reference | reference | |||
| Present | 317 | 0.58(0.46-0.73) | <0.001 | 0.49 (0.38-0.62) | <0.001 | |
Tab 6
Univariate and multivariate COX analyses of OS in patients with DAC undergoing surgery
| Variables | Cases | Univariate COX for OS | Multivariate COX for OS | |||
|---|---|---|---|---|---|---|
| HR(95%CI) | P value | HR(95%CI) | P value | |||
| Sex | ||||||
| Male | 374 | reference | ||||
| Female | 260 | 0.78(0.63-0.97) | 0.0243 | |||
| Age (year) | ||||||
| <65 | 266 | reference | reference | |||
| ≥65 | 368 | 1.76(1.41-2.2) | <0.001 | 1.41 (1.12-1.78) | 0.004 | |
| Race | ||||||
| White | 474 | reference | ||||
| Black | 96 | 1.39(1.05-1.84) | 0.023 | |||
| Others | 64 | 1.11(0.77-1.61) | 0.571 | |||
| Tumor size (mm) | ||||||
| <40 | 293 | reference | reference | |||
| ≥40 | 341 | 0.8(0.65-0.99) | 0.039 | 0.89 (0.72-1.1) | 0.292 | |
| Year of diagnosis | ||||||
| 2000—2012 | 269 | reference | reference | |||
| 2013—2021 | 365 | 0.74(0.59-0.92) | 0.006 | 0.8 (0.64-0.99) | 0.043 | |
| Grade | ||||||
| Well (Ⅰ+Ⅱ) | 398 | reference | reference | |||
| Poorly (Ⅲ+Ⅳ) | 236 | 1.34(1.08-1.66) | 0.007 | 1.38 (1.11-1.72) | 0.004 | |
| Radiotherapy | ||||||
| Others | 617 | reference | ||||
| Present | 17 | 0.52(0.26-1.06) | 0.072 | |||
| RNE | ||||||
| ≤18 | 391 | reference | reference | |||
| >18 | 243 | 0.7(0.56-0.88) | 0.003 | 0.68 (0.54-0.85) | 0.001 | |
| N stage | ||||||
| N0 | 199 | reference | ||||
| N1 | 205 | 2.13(1.58-2.89) | <0.001 | |||
| N2 | 230 | 3.13(2.34-4.19) | <0.001 | |||
| TNM stage | ||||||
| Ⅰ | 19 | reference | reference | |||
| ⅡA | 100 | 0.56(0.23-1.37) | 0.203 | 0.66 (0.27-1.63) | 0.367 | |
| ⅡB | 80 | 1.3(0.54-3.08) | 0.557 | 1.37 (0.57-3.26) | 0.48 | |
| ⅢA | 205 | 1.84(0.81-4.18) | 0.145 | 1.96 (0.86-4.46) | 0.11 | |
| ⅢB | 230 | 2.7(1.2-6.11) | 0.016 | 2.96 (1.31-6.71) | 0.009 | |
| Chemotherapy | ||||||
| Other group | 317 | reference | ||||
| Present | 317 | 0.51(0.41-0.63) | <0.001 | 0.44 (0.35-0.55) | <0.001 | |
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