[Long-term survival outcomes and prognostic factors following radical resection of pancreatic body and tail cancer: a retrospective analysis of 992 patients].

Objective: To investigate the survival outcomes and prognostic factors in patients undergoing radical resection for pancreatic body and tail cancer. Methods: A retrospective case series study was conducted on 992 patients who underwent radical resection for pancreatic body and tail cancer at the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2024. In this study, 577 cases (58.2%) were male and 415 cases (41.8%) were female,with an age of (65±9) years (range: 26 to 86 years). Follow-up continued until December 2024. Survival rates were estimated using the Kaplan-Meier method,and prognostic factors were identified using univariate and multivariate Cox proportional hazards models. Results: Among 992 patients, open surgery was the predominant approach (89.1%,884/992), and radical antegrade modular pancreatosplenectomy was performed in 317 patients (31.9%). Combined organ resection,venous resection,and arterial resection were performed in 23.5% (233/992), 9.3% (92/992), and 11.2% (111/992) of patients,respectively. The rates of R0, R1-1 mm, and R1-direct resections were 49.8% (494/992), 41.5% (412/992), and 8.7% (86/992), respectively. Stage ⅡB was the most common TNM stage (32.2%, 319/992). A total of 801 patients (80.8%) received adjuvant chemotherapy. The median follow-up period (M(IQR)) was 32.0(8.8) months (range:3.2 to 105.3 months),during which 508 patients (51.2%) died. The overall median survival (OS) time was 26.4 months,with 1-,3-, and 5-year survival rates of 79.0%,40.0%, and 29.0%, respectively. Histological subtype analysis showed that the median OS time was 26.7 months for pancreatic ductal adenocarcinoma (PDAC,n=855), 58.9 months for invasive intraductal papillary mucinous carcinoma (IPMC,n=32), and 15.7 months for adenosquamous carcinoma of pancreas (ASCP, n=73) (P=0.001). Among PDAC patients, adjuvant chemotherapy significantly improved survival (29.1 months vs. 14.4 months, P<0.01);in IPMC patients, adjuvant chemotherapy also extended survival (65.7 months vs. 58.9 months,P=0.047). Although ASCP patients receiving chemotherapy had a longer median OS time than those without (18.8 months vs. 8.9 months), but the difference was not statistically significant (P=0.151). Multivariate Cox regression analysis in PDAC patients indicated that adjuvant chemotherapy, R0 resection, T stage,N stage,and tumor differentiation were independent prognostic factors (P<0.01). The median OS time by TNM stage was:not reached for stage ⅠA, 51.6 months for stage ⅠB, 25.5 months for stage ⅡA, 23.7 months for stage ⅡB, 23.0 months for stage Ⅲ, and 14.4 months for stage Ⅳ. The median OS time for R0, R1-1 mm, and R1-direct resections was 34.1, 24.7, and 15.7 months,respectively (P<0.01). Conclusion: Adjuvant chemotherapy, R0 resection,tumor stage, and differentiation are independent prognostic factors for pancreatic body and tail cancer who undergo radical resection.