胰体尾癌患者的预后因素分析  

Prognostic factors of carcinoma of the body and tail of the pancreas

作　　者：丁泊文[1] 张倜[1] 崔云龙[1] 李慧锴[1] 丁守成[2] 李强[1] 

机构地区：[1]天津医科大学附属肿瘤医院肝胆肿瘤科、天津市肿瘤防治重点实验室,300060 [2]天津市蓟县人民医院普通外科,301900

出　　处：《中华消化外科杂志》2013年第8期564-568,共5页Chinese Journal of Digestive Surgery

基　　金：教育部新世纪优秀人才支持计划（2006-2009）

摘　　要：目的探讨影响胰体尾癌患者预后的相关因素。方法回顾性分析1998年1月至2008年12月天津医科大学附属肿瘤医院收治的64例行根治性切除术的胰体尾癌患者的临床资料。患者术前均行腹部超声、CT检查及肿瘤标志物检测了解疾病情况，术前未接受新辅助化疗，采用根治性手术方案，术后进行化疗、生物治疗和放射治疗。收集患者的性别、年龄、腰背疼痛、肿瘤部位、肿瘤最大直径、分化程度、手术方式、淋巴结转移、淋巴结转移率、胰腺内神经浸润、胰腺外神经浸润、胰腺被膜浸润、脾动脉浸润、脾静脉浸润、腹膜后软组织浸润、小静脉浸润、TNM分期等指标。采用Kaplan-Meier法绘制生存曲线，生存情况分析采用Log-rank检验，单因素分析采用，检验，采用COX风险模型进行多因素预后分析。结果64例患者均接受R0切除，平均清扫淋巴结数目为15枚（12～22枚）。64例患者中，术后发生胰液漏5例、胃排空障碍3例、腹腔感染1例、下肢深静脉血栓形成1例，无围手术期死亡。64例患者均为导管腺癌或囊腺癌，其中高分化9例、中分化35例、低分化20例；TNMIA期4例、ⅠB期9例、ⅡA期17例、ⅡB期34例。44例患者死于肿瘤复发或转移，其中26例为局部复发、18例为远处转移。患者1、3、5年生存率分别为42．2％、17．2％、15．6％，中位生存时间为19．0个月。单因素分析结果表明：腰背疼痛、肿瘤最大直径、分化程度、淋巴结转移、淋巴结转移率、胰腺外神经浸润、脾动脉浸润和TNM分期是影响患者预后的因素（X^2=10．658，8．371，18．910，6．605，28．382，14．571，19．476，32．155，P〈0．05）；多因素分析结果表明：肿瘤的分化程度、淋巴结转移率、胰腺外神经浸润、脾动脉浸润、TNM分期是影响患者预后的独立危险因素（RR=2．509，2．107，6．692，5．109，4．784，P〈0．05�Objective To investigate the clinical and pathological prognostic factors of the carcinoma of the body and tail of the pancreas. Methods The clinical data of 64 patients with the carcinoma of the body and tail of the pancreas who received radical resection at the Cancer Hospital of Tianjin Medical University from January 1998 to December 2008 were retrospectively analyzed. Abdominal ultrasound, computed tomography and tumor markers detection were eanied out preoperatively to team the condition of the patients. No patient received neo- adjuvant therapy before operation, and chemotherapy, biotherapy and radiotherapy were applied to all the patients after radical resection. Indicators including the gender, age, onset of back pain, site, diameter and differentiation of tumors, operative procedure, lymph node metastasis, metastatic rate of lymph nodes, extra- and intra-pancreatic neural invasion, splenic artery invasion, splenic vein invasion, retroperitoneal soft tissue infiltration, venulae infil- tration and TNM staging were collected. The survival curve was drawn by Kaplan-Meier method, and the survival was analyzed by Log-rank test. Univm＇iate and multivariate analysis were carried out by chi-square test and COX proportional hazards model, respectively. Results All patients received R0 resection, and the mean number of lymph node resected was 15 （range, 12-22）. There were 5 patients with pancreatic leakage, 3 with delayed gastric emptying, 1 with peritoneal infection, and 1 with deep venous thrombosis, no perioperative mortality was detected. All the 64 patients were with ductal adenocarcinoma and cystadenocarcinoma, and 9 patients were with high differentiated tumor, 35 with moderate differentiated tumor and 20 with low differentiated tumor. There were4 patients with tumor in the TNM ⅠA stage, 9 in the TNM IB stage, 17 in the TNM ⅡA stage and 34 in the TNM ⅡB stage. Twenty-six patients died of tumor local recurrence and 18 died of tumor distal metastasis. The 1-, 3-, 5-year survival rates were 42.2%,

关 键 词：胰腺肿瘤 外科手术 预后 

分 类 号：R735.9[医药卫生—肿瘤]