化疗联合放射治疗对不能手术的壶腹周围癌患者的疗效观察  

Gemcitabine and radiotherapy improve the quality of life of patients with unresectable advanced peri-amp- ullary carcinoma

作　　者：王涛[1] 刘宏[1] 胡鹏[1] 付卫江[1] 梁业民[1] 程玉峰[1] 

机构地区：[1]山东大学齐鲁医院放疗科,250012

出　　处：《中华肝胆外科杂志》2012年第9期688-691,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨吉西他滨联合放射治疗或单纯化疗治疗晚期壶腹周围癌的疗效。方法回顾性分析我院2007年1月至2010年12月收治的134例晚期壶腹周围癌患者的临床及随访资料并结合文献讨论。结果本组134例晚期壶腹周围癌患者中男83例，女51例。年龄28～83岁不等，平均（62．49±11．41）岁。所有患者均经病理证实为壶腹周围癌。在86例接受手术的患者中，32例伴有腹腔广泛转移，27例伴有肝脏或胃等脏器转移，27例伴有腹部主要血管侵犯。86例中，有55例接受了单纯剖腹探查术，31例接受了包括剖腹探查＋胆肠吻合术在内的姑息治疗。在所有患者中，有45例接受了单纯化疗治疗，其余67例接受了化疗＋放疗治疗。所有患者均获随访，同时放化疗及单纯化疗均可改善患者的生活质量，临床受益率分别为73．1％和57．8％；总体生存期（14．27±1．06）个月，中位生存期11（95％CI，8．95±13．05）个月，1年和3年生存率分别为43％和10％。对患者预后进行单因素分析显示性别、年龄、有无腹水、曾接受的手术治疗以及治疗方式与患者的生存时间无关；Karnofsky体力状态评分以及有无黄疸与生存时间相关。体力状态评分越低，患者预后越差；有黄疸的患者预后较差。进一步行多因素分析，Karnofsky体力状态评分是患者生存的独立预测因素。结论晚期壶腹周围癌患者的预后差，单纯化疗与化疗联合放疗可以改善患者的生活质量，Karnof—sky体力状态评分是患者生存的独立预测因素。Objective To investigate the survival of advanced stage periampullary carcinoma and its prognostic factors. Methods The clinical data and follow-up of 134 patients with advanced stage periampullary carcinoma admitted to our hospital between January 2007 and December 2010 were ret- rospectively collected and analyzed. Results Of 134 patients, there were 83 males and 51 females. The mean age±S. D. was 62.49±11.41 （28-83）. For the 86 patients who underwent surgery, 32 had extensive peritoneal metastases on surgical exploration, 27 had metastases/involvement of the liver or stomach, and 27 had major vessel infiltration. For these 86 patients, 55 received surgical exploration, whereas 31 had surgical exploration plus bypass anastomosis. 45 patients received chemotherapy, while 67 received chemotherapy plus radiotherapy. The improvements in quality of life and in clinical response rate after concurrent ehemoradiotherapy or chemotherapy alone were 73.1% and 57.8 %, re- spectively. The overall survival was 14.27±1.06 months. The median survival time was 11 （8.95± 13.05） months. The 1- and 3-year survival rates were 43% and 10%, respectively. Karnofsky performance status, and the presence or absence of jaundice co-related with poor prognosis on single fac- tor analysis. The Karnofsky performance status was an independent survival predictor on muhifaetor analysis. Conclusions The prognosis of patients with advanced stage periampullary carcinoma was poor. Chemotherapy with or without radiotherapy had similar impact on overall survival, Karnofsky performance status was an independent survival predictor.

关 键 词：壶腹周围癌 吉西他滨 放射治疗 

分 类 号：R735.0[医药卫生—肿瘤]