中国实用外科杂志

中国实用外科杂志

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胰腺癌术后预后因素分析及AJCC第8版TNM分期意义评价（附143例报告）

李佶松，田孝东，高红桥，马永蔌，庄    岩，杨尹默   

  1. 北京大学第一医院普通外科，北京100034
  • 出版日期:2018-07-01 发布日期:2018-07-09

  • Online:2018-07-01 Published:2018-07-09

摘要：

目的    探讨影响胰腺癌术后远期预后的危险因素，评价美国癌症联合委员会（AJCC）第8版TNM分期的临床价值。方法    回顾性分析2010年1月至2016年12月行手术切除的143例胰腺导管腺癌病人的临床病理及随访资料，通过Cox回归模型和Kaplan-Meier法分析预后相关危险因素。结果    胰头癌100例（69.9%），胰体尾癌43例（30.1%）；行胰十二指肠切除术100例，胰体尾及脾切除术42例，全胰腺切除术1例，其中联合器官切除10例（7.0%）；R0切除55例（38.5%），R1切除84例（58.7%），R2切除4例（2.8%）；术后辅助治疗75例（52.4%）。病人术后中位总生存期（OS）为20（95%CI 17.5~22.5）个月，中位无病生存期（DFS）为14（95%CI 12.5~15.5）个月。单因素及多因素分析提示，AJCC T分期、N分期、手术切缘状态、肿瘤分化程度、联合血管切除与否、中性粒细胞/淋巴细胞比（NLR）≥2、CA19-9≥400 kU/L、辅助化疗是病人预后的独立影响因素（P<0.05）。AJCC第8版TNM分期对于预后具有良好的预测价值。结论    AJCC TNM分期在一定淋巴结清扫数目的基础上可准确预测病人预后，R0或R1切除及术后辅助治疗可显著改善病人预后。

关键词: 胰腺癌, 预后因素, 手术切缘, 辅助化疗, TNM分期

Abstract:

Prognostic factors for long-term survival in patients with pancreatic adenocarcinoma and evaluation of 8th AJCC staging：A report of 143 cases        LI Ji-song，TIAN Xiao-dong，GAO Hong-qiao, et al. Department of General Surgery，Peking University First Hospital，Beijing 100034，China
Corresponding author：YANG Yin-mo，E-mail：yangyinmo@263.net
Abstract    Objective    To analyze clinicopathological factors influencing the prognosis of the patients with resectable pancreatic ductal adenocarcinoma (PDAC) and evaluate the 8th AJCC TNM staging. Methods    A total of 143 cases of PDAC underwent resection in Department of General Surgery of Peking University First Hospital from January 2010 to December 2016. The clinical and survival data were analyzed retrospectively for prognostic factors. Results    A total of 100 patients (69.9%) with pancreatic head carcinoma underwent pancreatoduodenectomy, while 43 patients (30.1%) with tumors located in the pancreatic body/tail underwent distal pancreatectomy or total pancreatectomy. Multivisceral resections were performed in 10 patients (7.0%). R0 margins were achieved in 55 patients (38.5%). The percentage of R1 and R2 resections were 58.7% and 2.8%, respectively. A total of 75 patients (52.4%) received adjuvant chemotherapy. The median overall survival (OS) time was 20 (95%CI 17.5-22.5) months and disease-free survival (DFS) time was 14 (95%CI 12.5-15.5) months. Univariate and multivariate analysis revealed that AJCC T staging, N staging, R2 resection margin status, low- or un-differentiated grade, vascular resection, neutrophil-to-lymphocyte ratio (NLR) ≥2, CA19-9≥400 U/mL and adjuvant chemotherapy were prognostic factors（P<0.05）. The 8th AJCC TNM staging was significantly associated with prognosis. Conclusion    TNM staging system could predict prognosis accurately on the basis of adequate examined lymph nodes. R0/R1 resection and adjuvant chemotherapy could improve the survival of the patients significantly.

Key words: pancreatic cancer, prognostic factor, resection margin status, adjuvant chemotherapy, TNM staging