中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (04): 417-422.DOI: 10.19538/j.cjps.issn1005-2208.2022.04.11

• 论蓍 • 上一篇    下一篇

胰腺腺鳞癌临床病理特征分析及预后模型建立

张国虓，李    勃，尹笑逸，高绥之，沈    硕，王    健，任义伟，韩家伟，郭世伟，金    钢   

  1. 海军军医大学附属长海医院肝胆胰腺外科，上海 200433
  • 出版日期:2022-04-01 发布日期:2022-04-04

  • Online:2022-04-01 Published:2022-04-04

摘要： 目的    探讨胰腺腺鳞癌（ASCP）病人临床病理特征对术后预后的预测价值。方法    回顾性分析2012年10月至2019年9月海军军医大学附属长海医院肝胆胰腺外科行根治性切除术的126例ASCP病人的临床病理资料和随访资料。分析不同Ki-67指数病人的预后差异，采用最小P值法确定Ki-67指数的截断值（40%）。对临床病理特征进行单因素和多因素分析以确定预后影响因素，并依此建立列线图 （Nomogram）预后模型，并使用决策曲线分析法（DCA）进行评估。结果    高Ki-67指数组脉管癌栓阳性病人的比例高于低Ki-67指数组（P=0.005）。单因素分析显示，肿瘤分化程度、肿瘤直径、T分期、N分期、脉管癌栓和Ki-67指数与ASCP病人术后生存相关；多因素分析显示，肿瘤分化程度、肿瘤直径、N分期与Ki-67指数均为ASCP病人术后独立预后预测因素，据此建立Nomogram预后预测模型，内部验证的C-index为0.714（95%CI 0.663-0.765），高于TNM分期预后模型（C-index=0.581，95%CI 0.523-0.639），在预测总生存时间方面表现出良好的准确性。DCA 同样显示 Nomogram 预后模型较 TNM分期预后模型具有更高的临床获益。结论    低分化、肿瘤直径>4 cm、N分期（N1+N2）、Ki-67指数＞40%的ASCP病人术后预后不良，据此建立的Nomogram预后模型较TNM分期预后模型具有更高的准确性及临床获益。

关键词: 胰腺腺鳞癌, Ki-67指数, 临床病理特征, 预后

Abstract: Clinicopathological features and prognostic model establishment of adenosquamous carcinoma of the pancreas          ZHANG Guo-xiao，LI Bo，YIN Xiao-yi，et al. Department of Hepatobiliary Pancreatic Surgery，Changhai Hospital Affiliated to Navy Medical University，Shanghai 200433，China
Corresponding author：JIN Gang，E-mail：jingang@smmu.edu.cn
Abstract    Objective    To clarify the prognostic value of clinicopathological features for radical resection of adenosquamous carcinoma of the pancreas（ASCP）. Methods    The clinical and pathological data and follow-up data of 126 patients who underwent radical resection of ASCP at the Department of Hepatobiliary Pancreatic Surgery in Changhai Hospital from October 2012 to September 2019 were retrospectively analyzed. Immunohistochemical method was used to detect Ki-67 index in the resected tissues. Analyze the differences in patients with different Ki-67 indexes. The cutoff value of Ki-67 index(40%) was evaluated by the Minimum P-value approach. The differences of baseline characteristics between the two groups were compared by the chi-square test. The univariate and multivariate analyses were performed to identify independent prognostic factors. The Nomogram prognostic model was established. At the same time，decision curve analysis（DCA）was used to evaluate the model. Results    The proportion of patients with lymphovascular tumor embolus in high Ki-67 index group is higher than that in low Ki-67 index group（P=0.005）. Univariate analysis showed that differentiation，tumor diameter，T stage,N stage，lymphovascular tumor embolus and Ki-67 index were associated with survival. Multivariate analysis showed that differentiation，tumor diameter，N stage and Ki-67 index were independent prognostic predictors of ASCP. The Nomogram prognostic model based on this conclusion shows good accuracy in predicting overall survival：the C-index of internal validation was 0.714（95%CI 0.663-0.765），higher than that of TNM stage prognostic model（C-index=0.581，95%CI 0.523-0.639）. Decision curve analysis（DCA） also suggested that the Nomogram prognostic model has a higher clinical benefit than the TNM prognostic stage model. Conclusion    Patients with poor differentiation，tumors greater than 4 cm，N stage（N1+N2） and Ki-67 index＞40% have the poor prognosis. The Nomogram established according to this conclusion has higher accuracy and clinical benefit than the TNM prognostic stage model.

Key words: adenosquamous carcinoma of the pancreas, Ki-67 index, clinicopathologic features, prognosis