胰腺癌术后肝转移的治疗策略及预后分析  

Prognostic analysis of asynchronous liver metastasis in patients with pancreatic cancer

作　　者：孟泽武[1] 陈燕凌[1] 朱金海[1] 韩圣华[1] 周良艺[1] 

机构地区：[1]福建医科大学附属协和医院肝胆外科,福建福州350001

出　　处：《中华胰腺病杂志》2015年第1期34-38,共5页Chinese Journal of Pancreatology

摘　　要：目的分析胰腺癌术后非同期肝转移患者的治疗过程和疗效及不同治疗策略对患者生存期的影响。方法回顾性分析福建医科大学附属协和医院2006年1月至2012年1月所收治的48例胰腺癌术后肝转移患者的病例资料。结果48例胰腺癌患者中术后6个月内发生肝转移27例，1、3、5年生存率分别为22．2％、3．7％和0，中位生存时间为6个月；6个月以上发生肝转移21例，1、3、5年生存率分别为85．7％、30．6％和9．2％，中位生存时间为15个月，两者差异有统计学意义（P〈0．01）。胰腺癌术后行吉西他滨化疗者6个月内发生肝转移的概率为33．3％（8／24），1、3、5年无病（无肝转移）生存率分别为20．8％、4．3％、0，中位无病生存时间为8个月；未行术后化疗者6个月内发生肝转移的概率为79．2％（19／24），l、3、5年无病（无肝转移）生存率分别为4．2％、0、0，中位无病生存时间为3个月，两者差异均有统计学意义（P值均〈0．01）。胰腺癌术后化疗联合肝转移癌切除患者总体生存率优于其他治疗组（P值均〈0．01）；术后化疗联合介入治疗患者总体生存率优于单纯介入组、化疗组和未行针对肿瘤治疗的临床观察组（P值均〈0．05）；介入组、化疗组和临床观察组患者总体生存率差异无统计学意义。结论胰腺癌根治术后6个月内发生肝转移的患者预后较差，术后化疗能延缓肝转移发生时间。对可切除患者，化疗联合手术切除肝转移灶是首选治疗方法，化疗联合介入治疗疗效优于单一种治疗。Objective To analyse tratment strategies and to evaluate the relation between different therapies and survival rate of patients of with asynchronous liver metastases after pancreatic cancer surgery （PCLM）. Methods From January 2006 to January 2012, 48 patients with PCLM were included in this study, and their medical records were retrospectively analyzed. Results Among the 48 patients, 27 cases of liver metastases were found within six months after surgery, and the survival rate for 1, 3 and 5 years was 22.2% , 3.7% and 0% , respectively, with the median survival of 6 months, and 21 cases of liver metastases were found after six months, and the survival rate for 1, 3 and 5 years was 85.7% , 30.6% and 9.2% , with the median survival of 15 months, and the difference between the two groups was statistically significant （ P 〈 O. 01 ）. After pancreatic cancer surgery and adjuvant gemcitabine chemotherapy, the probabi｜ity of liver metastases was 33.3% （8/24） within six months, the median disease-free survival time was 8 months and the disease-free survival rate for 1, 3 and 5 years was 20.8% , 4.3% and 0%. For patients without adjuvant gemcitabine chemotherapy, the probability of liver metastases was 79.2% （ 19/24 ） , the median disease-free survival time was 3 months and the disease-free survival rate for 1, 3 and 5 years was 4.2% , 0% and 0% , and the difference between the two groups was statistically significant （P 〈0.01 ）. The overall survival for patients undergoing resection of liver metastases combined with gemcitabine treatment was better than the other groups （P 〈 0.01 ）. And the overall survival for patients undergoing transhepatic arterial embolization （TACE） combined with gemcitabine treatment was better than TACE group, gemcitabine group or the observation group （P 〈0.05 ）. There were no difference in overall survival between TACE group, gemcitabine group and observation group. Conclusions Pancreatic cancer patients who develop liver metastasis within six months af

关 键 词：胰腺肿瘤 肝转移 手术后期间 预后 

分 类 号：R735.9[医药卫生—肿瘤]