胰腺癌辅助化疗的预后与复发因素分析  

Analysis of prognostic and recurrence factors of pancreatic cancer received adjuvant chemotherapy

作　　者：方乐平[1] 徐晓燕[1] 姬玉 黄普文[1] 

机构地区：[1]南京医科大学第一附属医院肿瘤科,南京210029

出　　处：《临床肿瘤学杂志》2017年第9期812-816,共5页Chinese Clinical Oncology

摘　　要：目的探讨影响胰腺癌辅助化疗者预后及复发的因素,以期早期发现复发来提高远期生存。方法回顾性分析2008年1月至2015年9月77例胰腺癌切除术后行辅助化疗患者的资料,分析影响胰腺癌辅助化疗的预后及复发的因素。结果单因素分析显示分化程度、切缘情况、肿瘤最大径、脉管内癌栓、血管侵犯、淋巴结转移、术前癌胚抗原(CEA)水平、中性粒细胞与淋巴细胞比值(NLR)及是否完成辅助化疗与预后有关(P<0.05);多因素分析显示淋巴结转移、低分化、R1切除及未完成辅助化疗是胰腺癌预后差的独立危险因素。肿瘤最大径、T分期、血管侵犯及术前CEA水平与胰腺癌复发有关,Logistic回归分析显示血管侵犯及术前CEA水平升高是胰腺癌复发的独立危险因素,且复发者复发后生存时间更短。结论对于胰腺癌辅助化疗患者,淋巴结转移、低分化、R1切除及未完成辅助化疗是影响预后的危险因素。血管侵犯及术前CEA水平升高者更易复发,且复发后生存时间更短,对这些易早期复发患者术前应重视评估病情及慎重考虑是否需要术前治疗。Objective To investigate the prognostic and recurrence factors of pancreatic cancer patients treated with adjuvant chemotherapy, so as to improve the long-term survival of the patients with early detection of recurrence. Methods Seventy-seven pan- creatic adenocarcinoma patients underwent resection with curative intent and received adjuvant chemotherapy from January 2008 to Sep- tember 2015 were enrolled in this study. Results The median survival for all patients was 20. 44 months. Univariate analysis identified differentiation, surgical margin status, tumor maximum diameter, intravascular cancer emboli, vascular invasion, lymph node metasta- sis, pre-operation CEA level, pre-operation neutrophil lymphocyte ratio （NLR） and postoperative chemotherapy were associated with prognosis. The multivariate analysis showed that lymph node metastasis, poorly differentiated, R1 resection and uncompleted adjuvant chemotherapy were negative prognosis factors. Univariate analysis of the maximum tumor size, T stage, vascular invasion and preopera- tive CEA levels was related to the recurrence of pancreatic cancer. Logistic regression analysis showed that invasion of blood vessels and elevated preoperative CEA levels were independent risk factors for recurrence of pancreatic cancer. Compared to patients without recur- rence, patients with recurrence have shorter survival time. Conclusion Lymph node metastasis, low differentiation, Rl resection, and incomplete adjuvant chemotherapy are prognostic factors for pancreatic cancer patients receiving adjuvant chemotherapy. Pancreatic cancer patients with vascular invasion and preoperative CEA level were more likely to relapse, recurrence and survival time shorter, so these patients to early recurrence should pay attention to the assessment of the disease and the need for preoperative treatment.

关 键 词：胰腺癌 辅助化疗 预后因素 复发 

分 类 号：R735.9[医药卫生—肿瘤]