扩大与标准胰十二指肠切除术对胰头癌患者影响预后的倾向性评分匹配分析  

Prognosis of patients with pancreatic head carcinoma undergoing extended versus standard pancreatoduodenectomy: a propensity score matching analysis

作　　者：王宇 周俊 吴晓俊 闵捷 赵凤庆 李皇保 WANG Yu,ZHOU Jun,WU Xiaojun,et al(Department of Hepatopancreatobiliary Surgery,the First Hospital of Jiaxing,Jiaxing 314000,China)

机构地区：[1]嘉兴市第一医院肝胆外科,314000

出　　处：《浙江医学》2018年第19期2138-2141,2154,共5页Zhejiang Medical Journal

摘　　要：目的采用倾向性评分匹配法均衡组间协变量后,比较扩大胰十二指肠切除术(EPD)与标准胰十二指肠切除术(SPD)对胰头癌患者预后的影响。方法回顾性分析美国SEER数据库1998至2013年共9 494例胰头癌患者的临床病理数据,经倾向性评分匹配后得到1 010例组间均衡新样本,EPD组与SPD组各505例,并用新样本作生存分析。结果匹配前9 494例患者总体1、3、5年癌症相关生存率分别为69.0%、29.0%、20.0%,中位生存期为20.33个月;EPD组患者1、3、5年癌症相关生存率分别为68.0%、30.0%、20.0%,中位生存时间为20.35个月;SPD组患者1、3、5年癌症相关生存率分别为69.0%、29.0%、20.0%,中位生存时间为19.92个月(P>0.05)。匹配后,基线资料在两组间均衡(均P>0.05)。匹配后1 010例患者总体1、3、5年癌症相关生存率分别为68.0%、29.0%、22.0%,中位生存期为19.80个月。EPD组患者1、3、5年癌症相关生存率分别为68.0%、31.0%、22.0%,中位生存时间为20.48个月,30d内病死率为2.2%。SPD组患者1、3、5年癌症相关生存率分别为67.0%、27.0%、21.0%,中位生存时间为19.21个月,30d内病死率为3.4%(P>0.05)。匹配后,有淋巴结转移的两组患者术后生存情况比较无统计学差异(P>0.05)。有远处转移的EPD组患者5年癌症相关生存率为16.0%,中位生存期为18.48个月;SPD组5年癌症相关生存率为11.0%,中位生存期为13.02个月;两组比较差异有统计学意义(P<0.05)。结论与SPD比较,EPD在一般情况下并不能获得更彻底的淋巴结清扫,改善预后的效果不明显,只有当胰头癌远处转移时有改善预后的效果。因此临床上对胰头癌患者行EPD治疗的选择应慎重,尽量减少因扩大手术而引起的损伤。Objective To explore the prognosis of patients with pancreatic head carcinoma undergoing extended pancreaticoduodenectomy （EPD） or standard pancreaticoduodenectomy （PD） using propensity score matching （PSM）. Methods Total 9494 patients with pancreatic head carcinoma were extracted from the US SEER database between 1998 and 2013,including 548 cases undergoing EPD （EPD group） and 8946 cases undergoing SPD （SPD group）. PSM function of SPSS softwarewas conducted to reduce confounding bias between the groups; and then the survival analysis was performed for the matcheddata. Results Before PSM, the 1-, 3- and 5-year cancer special survival rates of 9494 patients were 69%, 29% and 20% with amedian survival time of 20.33 months; the 1-, 3- and 5-year cancer special survival rates of EPD group were 68%, 30% and 20%witha median survival time of 20.35 months; while those of SPD were 69%, 29% and 20% witha median survival time of 19.92months（P 〉0.05）. Baseline data were balanced between the two groups after PSM（P 〉0.05）. The 1-, 3- and 5-year cancerspecial survival rates of 1010 pancreatic head carcinoma patients were 68%, 29% and 22% with a median survival time of 19.80months. The 1-, 3- and 5-year cancer special survival rates of EPD group were 68%, 31% and 22% witha median survival timeof 20.48 months and a 30-day mortality of 2.2%. The 1-, 3- and 5-year cancer special survival rates of SPD group were 67%,27% and 21% with a median survival time of 19.21months anda 30-day mortality of 3.4%（P 〉0.05）. There was no significant difference in survival of patients with lymph node metastasis between two groups. For patients with distant metastasis, the 5-year cancer special survival rate of EPD group was 16% witha median survival time of 18.48 months; while that of SPD group was 11%witha median survival time of 13.02 months（P〈0.05）. Conclusion EPD does not generally get more complete lymph node dis-section, and it does not significantly improve the prognosis, while EPD can only improve

关 键 词：胰头导管腺癌 扩大胰十二指肠切除术 标准胰十二指肠切除术 倾向性评分匹配 SEER 癌症相关生存率 

分 类 号：R735.9[医药卫生—肿瘤]