中国实用外科杂志

中国实用外科杂志

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胰腺癌根治术后病人生存相关因素分析

徐    冬，陆子鹏，郭    峰，陈建敏，卫积书，尹    杰，张    凯，吴鹏飞，蔡宝宝，吕    楠，蒋奎荣，苗    毅   

  1. 南京医科大学第一附属医院胰腺中心，江苏南京 210029
  • 出版日期:2017-07-01 发布日期:2017-06-30

  • Online:2017-07-01 Published:2017-06-30

摘要：

目的    探讨影响胰腺癌根治性切除病人术后生存的相关因素。方法    回顾性分析2010年1月至2013年12月南京医科大学第一附属医院胰腺中心行根治性手术的275例胰腺癌病人的临床资料，包括临床病理资料和生存随访资料。结果    随访18（9～36）个月，共216例（78.5%）病人死亡，总体中位生存时间为15.1个月（95%CI 11.7～18.4），1、3、5年存活率分别为63.2%、23.1%、11.8%。行术后化疗病人术后生存时间29.1个月（19.5～38.7），1、3、5年存活率分别为78.6%、43.6%、25.4%。Cox回归分析提示，术前CA19-9水平、肿瘤分化水平、肿瘤长径、阳性淋巴结比、镜下血管侵犯、术后化疗是胰腺癌病人术后生存的独立影响因素（P<0.05）。进一步按手术方式进行分层分析，行胰十二指肠切除术病人术后生存独立影响因素包括术前CA19-9水平、肿瘤分化、肿瘤长径、血管侵犯、术后化疗（P<0.05），胰体尾切除病人术后生存独立影响因素包括肿瘤分化、血管侵犯、阳性淋巴结比、术后化疗（P<0.05）。结论    术前高CA19-9水平、高阳性淋巴结比、肿瘤分化水平差以及有镜下血管侵犯的胰头癌和胰体尾癌病人预后更差。根治性手术基础上联合辅助化疗可显著延长胰腺癌病人存活时间，是改善胰腺癌预后的重要手段。

关键词: 胰腺癌, 根治性切除, 术后化疗, 预后

Abstract:

Factors influencing the prognosis of patients with pancreatic cancer after intended radical surgery        XU Dong，LU Zi-peng，GUO Feng，et al. Pancreas Center，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
Corresponding authors：JIANG Kui-rong，E-mail：jiangkuirong@163.com；MIAO Yi，E-mail: miaoyi@njmu.edu.cn
Abstract    Objective    To analyze the factors influencing the prognosis of patients with pancreatic cancer after intended radical surgery. Methods    The clinical data of 275 cases of pancreatic cancer accepted intended radical surgery in Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2013 were analyzed retrospectively. Results    A total of 216 cases（78.5%） died during 18（9-36）months of follow-up. The overall median survival time was 15.1（95%CI 11.7-18.4）months. The 1-，3-，5-year survival rates were 63.2%，23.1%，11.8%，respectively. The median survival time of patients received adjuvant chemotherapy was 29.1（19.5-38.7） months. The 1-，3-，5-year survival rates were 78.6%, 43.6%, 25.4%，respectively. Cox regression model showed that preoperative serum CA19-9，differentiation of tumor，tumor size，microscopic vascular invasion，positive nodal ratio，adjuvant chemotherapy were the independent risk factors influencing the prognosis of patients with pancreatic cancer after intended resection（P<0.05）. Further stratification analysis showed preoperative serum CA19-9，differentiation of tumor，tumor size，microscopic vascular invasion，adjuvant chemotherapy were the independent risk factors influencing the prognosis of patients with pancreaticoduodenectomy（P<0.05），and differentiation of tumor，positive nodal ratio，microscopic vascular invasion，adjuvant chemotherapy were the independent risk factors influencing the prognosis of patients with distal pancreatectomy. Conclusion    Pancreatic cancer patients,either in the head or body-tail, with higher preoperative CA19-9, higher positive nodal ratio, and poorer tumor differentiation and microscopic vascular invasion have a worse prognosis. Adjuvant chemotherapy, which can significantly prolong patients' survival after radical resection, should be encouraged.

Key words: pancreatic cancer, radial resection, adjuvant chemotherapy, prognosis