不可切除的胰腺癌TAI/TACE治疗后回顾性生存分析  

Retrospective survival analysis of patients with unresectable pancreatic carcinomas after receiving transarterial infusion chemotherapy and transarterial chemoembolization treatment

作　　者：李国平[1] 龚高全[1] 王建华[1] 颜志平[1] 陈颐[1] 程洁敏[1] 刘凌晓[1] 王小林[1] 

机构地区：[1]复旦大学附属中山医院介入治疗科,200032

出　　处：《介入放射学杂志》2015年第2期118-123,共6页Journal of Interventional Radiology

基　　金：上海市级医院新兴前沿技术项目(SHDC12010120)

摘　　要：目的通过对不可切除的胰腺癌患者159例经TAI/TACE治疗后的回顾性生存分析,评估影响胰腺癌介入治疗后生存期的因素。方法收集并分析159例胰腺癌患者的TAI/TACE治疗病史资料,并对影响胰腺癌患者TAI/TACE治疗后生存期的因素和治疗模式进行单因素及COX模型多因素分析。结果 159例患者总随访中位生存期（m ST）为10.32个月,总的介入治疗后m ST为8.11个月,总1年累积生存率27.0%,2年累积生存率11.0%,3年累积生存率2.0%,5年累积生存率为0.6%。根据临床反应率（CBR）评估判定介入治疗后能缓解症状的介入次数平均值为2.6次。单因素分析显示影响胰腺癌介入治疗后MST的主要因素有：初次介入治疗前CA19-9值,及其术后变化,初次介入前KPS评分,初次介入前症状,介入治疗前肝功能分级,介入治疗前有无手术史,介入治疗次数。而年龄,性别,初次介入前血红蛋白值,肿瘤分期（Ⅱ~Ⅲ期与Ⅳ期）,初次介入时CEA的值,初次介入前后CEA的变化,治疗药物（是否含吉西他滨联合奥沙利铂）,治疗方案（TAI/TACE）,术前是否存在糖尿病,肿瘤部位（是否为胰头部）,病理是否为导管腺癌,均显示差异无明显统计学意义。多因素分析显示对介入治疗后生存期有影响的独立因素是：开始介入治疗时肝功能分级,初治时KPS评分,有无原发灶手术切除史。结论 TAI/TACE对于胰腺癌患者在改善患者症状和延长中位生存期方面有一定的治疗作用,介入治疗后生存期与患者的体力状态,存在症状和有无早期手术治疗有关。Objective To investigate the factors that may influence survival time in patients with inoperable pancreatic carcinomas who have received transarterial infusion chemotherapy（TAI） and transarterial chemoembolization（TACE） treatment through a retrospective survival analysis. Methods A total of 159 patients with inoperable pancreatic carcinomas who had received TAI and TACE were enrolled in this study. The clinical data were retrospectively analyzed. By using univariate and Cox model multivariate statistical analysis method the factors influencing survival time and the therapeutic scheme were analyzed.Results The total following-up median survival time（MST） of 159 patients was 10.32 months, and the total post-interventional-therapy MST was 8.11 months. The one-year, 2-year, 3-year, and 5-year cumulative survival rates were 27.0%, 11.0%, 2.0% and 0.6% respectively. The average times of interventional procedure which could alleviate clinical symptoms, judged by clinical benefit rate（CBR）, were 2.6 times. Univariate analysis showed that the important factors that affected the post-interventional-therapy MST included blood CA199 value before initial treatment, blood CA199 change after the first treatment, preoperative KPS scores,preoperative clinical symptoms, preoperative liver function grading, the presence or absence of operation history and the times of interventional procedure. No statistically significant differences in median survival time existed between different age, sex, preoperative serum hemoglobin levels, tumor stages（stage Ⅱ-Ⅲvs. stage Ⅳ）, CEA values, medication（gemcitabine plus oxaliplatin）, therapeutic schemes, pre-existing diabetes mellitus, tumor sites（pancreatic head or other part） and pathologic types（ductal adenocarcinoma or other type）. Multivariate analysis indicated that the independent factors related to survival time included preoperative KPS scores, liver function grading and operation history of the primary lesion. Conclusion TAI together with TACE carri

关 键 词：胰腺癌 介入治疗 中位生存期 生存分析 

分 类 号：R735.9[医药卫生—肿瘤]