胰腺癌术后肿瘤初始复发部位对预后的影响  

The impact of initial recurrence site on the prognosis for pancreatic cancer after radical operation

作　　者：童敬澍 毛书奇 杨勇[1] 蔡星晨 宓宏潮 陆才德[1] Tong Jingshu;Mao Shuqi;Yang Yong;Cai Xingchen;Mi Hongchao;Lu Caide(Department of Hepatopacreatobiliary Surgery,Affiliated Lihuili Hospital,Ningbo 315040,China)

机构地区：[1]宁波大学附属李惠利医院肝胆胰外科,宁波315040

出　　处：《中华胰腺病杂志》2022年第4期260-266,共7页Chinese Journal of Pancreatology

基　　金：宁波市科技创新团队(2013B82010);宁波市医疗卫生品牌学科项目(PPXK2018-03)

摘　　要：目的探讨胰腺癌根治性手术后初始复发部位对患者预后的影响。方法回顾性分析2015年1月至2021年6月间宁波大学附属李惠利医院172例行胰腺癌根治性手术切除且病理确诊为胰腺导管腺癌患者的临床资料,根据术后肿瘤初始复发或转移部位分为无复发、局部复发(残余胰腺或肠系膜血管、胰肠吻合口周围组织等处复发)、肝转移、腹腔或后腹膜转移、多部位复发及其他部位转移等。采用COX风险比率模型分析影响患者预后的危险因素,采用Kaplan-Meier法计算患者总生存期和无瘤生存期,绘制生存曲线,采用log-rank法比较不同复发部位及复发后不同治疗方案患者的生存期差异。结果172例患者术后12例局部复发,69例肝转移,25例腹腔或后腹膜转移,17例多部位复发,5例其他部位转移,44例未复发;中位随访时间15.5个月(3~69个月);患者中位总生存期为19个月(95%CI 16.273~21.727);术后1、3、5年累积生存率分别为71.0%、27.8%、20.2%。单因素分析结果显示CA125水平、肿瘤大小、淋巴结转移、脉管侵犯、肿瘤分化程度、辅助化疗、初始复发转移部位与患者总生存期显著相关(P值均<0.05);多因素分析结果显示,CA125≥30 IU/ml(OR=2.669,P=0.001)、脉管侵犯(OR=1.736,P=0.028)、肿瘤低分化(OR=1.604,P=0.027)、辅助化疗(OR=0.439,P<0.001)、初始复发转移部位(P值均<0.05)是影响患者总生存期的独立危险因素。172例患者的中位无瘤生存期为9个月(95%CI 7.075~10.925)。单因素分析结果显示,CA125水平、肿瘤大小、淋巴结转移、脉管侵犯与患者无瘤生存期显著相关(P值均<0.05);多因素分析结果显示,CA125水平(OR=1.640,P=0.026)、肿瘤大小(OR=1.774,P=0.011)、脉管侵犯(OR=1.563,P=0.034)是影响患者无瘤生存期的独立危险因素。胰腺癌术后,局部复发、其他部位转移、腹腔或后腹膜转移、多部位复发、肝转移患者的中位生存期分别为28、22、21、15�Objective To investigate the impact of initial recurrence site on the prognosis of patients with pancreatic cancer after radical operation.Methods Clinical data of 172 patients who underwent radical resection of pancreatic cancer and were pathologically confirmed as pancreatic ductal adenocarcinoma in Ningbo University Affiliated Lihuili Hospital from January 2015 to June 2021 were analyzed retrospectively.According to the classification of the initial recurrence or metastasis after operation:no recurrence,local recurrence(residual pancreas,mesenteric vein,pancreaticoenterostomy surrounding tissue),liver metastasis,abdominal or retroperitoneum metastasis,multiple site recurrence and other pattern recurrence.The effect on prognosis was analyzed by COX risk ratio model,the overall survival and recurrence-free survival were calculated by Kaplan-Meier,and the survival curve was drawn.Log-rank test was used to compare the survival rate of different recurrence sites and different treatments after recurrence.Results 12 patients had local recurrence,69 had liver metastasis,25 had abdominal or retroperitoneal metastasis,17 had multiple site recurrence,and 5 had other site recurrence and 44 had no recurrence.The median follow-up time was 15.5 months(3-69 months).The median overall survival was 19 months(95%CI 16.273-21.727).The 1-,3-and 5-year postoperative cumulative survival rate was 71.0%,27.8%and 20.2%,respectively.Univariate analysis showed that CA125,tumor size,lymph node metastasis,microvascular invasion,tumor differentiation degree,adjuvant chemotherapy,initial recurrence site were significantly correlated with overall survival(All P value<0.05).Multivariate analysis showed that CA125≥30 IU/ml(OR=2.669,P=0.001),microvascular invasion(OR=1.736,P=0.028),poor tumor differentiation(OR=1.604,P=0.027),adjuvant chemotherapy(OR=0.439,P<0.001),initial recurrence site(All P value<0.05)were the independent risk factors for overall survival.The median recurrence-free survival of 172 patients was 9 months(95%CI 7.075-10.925).

关 键 词：胰腺肿瘤 外科手术 肿瘤复发 预后 

分 类 号：R73[医药卫生—肿瘤]