术中胰腺切缘状态对胰头癌患者预后的影响  

The impact of intraoperative pancreatic resection margin status on prognosis of patients with pancreatic head cancer

作　　者：胡杨科 吴胜东[2] 王珂 黄静[2] 房炯泽[2] 陆才德[2] Hu Yangke;Wu Shengdong;Wang Ke;Huang Jing;Fang Jiongze;Lu Caide(Medical School of Ningbo University,Ningbo 315211,China;Department of Hepatobiliary and Pancreatic Surgery,Ningbo Medical Center Li Huili Hospital,Ningbo 315040,China)

机构地区：[1]宁波大学医学院,宁波315211 [2]宁波市医疗中心李惠利医院肝胆胰外科,宁波315040

出　　处：《中华肝胆外科杂志》2019年第11期850-854,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：宁波市医疗卫生品牌学科建设基金(PPXK2018-03);浙江省医药卫生科技项目(2019ZD074);宁波市医学科技计划项目(2011B01)。

摘　　要：目的探讨胰十二指肠切除术中胰腺切缘状态与胰头癌患者预后的关系,并分析术中胰腺切缘状态的影响因素。方法回顾性分析2012年3月至2018年10月间宁波李惠利医院收治的109例行手术切除且临床及随访资料完整的胰头癌患者资料,采用Kaplan-Meier法及Cox风险比例模型分析术中胰腺切缘情况及其他临床病理因素与预后的关系,采用logistic多因素回归分析术中胰腺切缘状态的影响因素。结果109例患者中,术中胰腺切缘阳性20例,阴性89例,所有患者术后病理切缘均为阴性。单因素分析显示,术前CA19-9、术前新辅助化疗、术中胰腺切缘状态、肿瘤大小、分化程度、脉管侵犯、神经侵犯、N分期与预后相关(均P<0.05),多因素分析显示CA19-9≥37 IU/ml、肿瘤最大径≥4 cm、肿瘤低分化、神经侵犯及淋巴结转移是影响预后的独立危险因素(均P<0.05)。虽然术中胰腺切缘阳性组与阴性组生存期存在差异(中位生存时间11个月比21个月,P<0.05),但其并不是影响预后的独立危险因素。组间临床病理因素分析显示切缘阳性组与阴性组在不良病理因素(肿瘤低分化、肿瘤直径≥4 cm、神经侵犯、脉管侵犯)分布上差异有统计学意义(P<0.05)。Logistic多因素分析显示肿瘤最大径≥4 cm(OR=5.72,95%CI:1.60~20.49)及低分化(OR=3.79,95%CI:1.20~11.95)是术中出现胰腺切缘阳性的独立危险因素。结论术中胰腺切缘阳性不是影响预后的独立危险因素,但是对生存有预测价值。切缘阳性的出现往往合并不良病理特征(如肿瘤直径大、分化程度低),预后往往较差,是肿瘤不良生物学行为的术中表现。Objective To study the impact of intraoperative pancreatic resection margin status on prognosis in patients with pancreatic head cancer.Methods The clinical and follow-up data of 109 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili Hospital from March 2012 to October 2018 were analyzed retrospectively.The association of intraoperative resection margin status and other clinicopathological factors on prognosis was analyzed by the Kaplan-Meier method and the Cox proportional hazard model.Logistic multivariate analysis was used to study factors influencing the margin status.Results Of 109 patients,20 had a positive intraoperative resection margin,and 89 had a negative margin.Postoperative pathological examination showed that all the patients had a negative surgical margin.Univariate analysis suggested that CA19-9 before operation,preoperative adjuvant chemotherapy,intraoperative pancreatic resection margin status,maximum diameter of tumor,perineural invasion,lymphovascular invasion,tumor differentiation,and N staging were significantly related to survival in the entire cohort(all P<0.05).Multivariate analysis showed CA19-9≥37 IU/ml,perineural invasion,lymph node metastasis,tumor diameter≥4 cm and poor tumor differentiation were independent risk factors of bad prognosis(P<0.05).Univariate analysis of prognosis showed significant differences in lifetime prognosis between the positive margin group and the negative group(median survival time:11 months vs.21 months,P<0.05),but a positive resection margin was not an independent risk factor on prognosis(P>0.05).Analysis of the clinicopathological factors between the two groups showed that in the positive pancreatic neck margin group,the distribution of adverse pathologic factors like low tumor differentiation,tumor diameter≥4 cm,perineural invasion and lymphovascular invasion were significantly different compared with the negative group(P<0.05).Tumor diameter≥4 cm(OR=5.72,95%CI:1.60~20.49)and low tumor differentiation(OR=3.79,95%CI:1.20~11.95)were in

关 键 词：胰腺肿瘤 切缘阳性 胰十二指肠切除术 预后 

分 类 号：R73[医药卫生—肿瘤]