胰腺癌腹腔淋巴结转移相关危险因素分析  

Risk factors of abdominal lymph node metastasis in pancreatic cancer

作　　者：徐俊明 曹爽 张欣雪[1] 刘喆 马军[1] 寇建涛[1] 贺强[1] Xu Junming;Cao Shuang;Zhang Xinxue;Liu Zhe;Ma Jun;Kou Jiantao;He Qiang(Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院肝胆外科,100020

出　　处：《北京医学》2022年第4期298-302,共5页Beijing Medical Journal

摘　　要：目的 总结胰腺癌腹腔淋巴结转移的相关危险因素。方法 选取2013年1月至2019年12月首都医科大学附属北京朝阳医院收治的249例接受根治性手术治疗的胰腺癌患者,对患者初诊时的一般情况、实验室指标、影像学检查、病理结果和总生存期等进行回顾性分析。结果 249例患者无术中死亡,围术期死亡4例,病死率1.6%。总体术后中位生存时间为15个月,1年、2年、3年和5年的总体生存率分别为55.1%、31.4%、22.3%和16.1%。有腹腔淋巴结转移169例(67.9%),无淋巴结转移组和有淋巴结转移组胰腺癌患者的术后中位生存时间分别为23个月和12个月,1年、2年、3年和5年总体生存率分别为73.8%、48.2%、37.1%和30.8%,46.3%、23.3%、15.6%和9.1%,差异有统计学意义(P<0.001)。单因素分析显示,与无淋巴结转移组比较,有淋巴结转移组胰腺癌患者的肿瘤分化程度、术前CA19-9水平、术前CEA水平、TNM分期的差异均有统计学意义(P<0.05);多因素logistic回归分析显示,术前CA19-9升高(>37 U/L)(OR=2.09, 95%CI:1.10~3.97)、肿瘤低分化(OR=2.07, 95%CI:1.09~3.95)是胰腺癌发生腹腔淋巴结转移的独立危险因素。结论 发生淋巴结转移的胰腺癌患者远期预后较差,术前CA19-9升高和肿瘤低分化是胰腺癌发生淋巴结转移的独立危险因素。Objective To summarize the risk factors of abdominal lymph node metastasis in pancreatic cancer.Methods The clinical data of 249 patients with pancreatic cancer were retrospectively analyzed from January 2013 to December 2019. All the patients received radical surgical treatment and were diagnosed as adenocarcinoma by postoperative pathology. The general conditions, laboratory indicators, imaging examinations, pathological results, and overall survival of the patients were analyzed. Log-rank test was used for survival comparison, logistic regression was used for analysis of risk factors related to lymph node metastasis. Results There was no intraoperative death in 249patients, and four patients died perioperatively, the perioperative mortality was 1.6%. The overall median survival time was 15 months, 1-year, 2-year, 3-year, 5-year survival rates were 55.1%, 31.4%, 22.3%, 16.1% respectively. There were 169 cases(67.9%) of abdominal lymph node metastasis. The median postoperative survival time was 23 months and 12 months for the patients with and without lymph node metastasis. The overall survival rates of 1-year, 2-year,3-year, 5-year were 73.8%, 48.2%, 37.1% and 30.8% in the group without lymph node metastasis, 46.3%, 23.3%,15.6% and 9.1% in the group with lymph node metastasis(P<0.001). Univariate analysis showed that compared with the group without lymph node metastasis, there were statistically significant differences in tumor differentiation,preoperative CA19-9 and CEA level, TNM stage in the group with lymph node metastasis. Multifactor analysis showed elevated preoperative CA19-9(>37 U/L)(OR=2.09, 95%CI: 1.10-3.97), low tumor differentiation degree(OR=2.07,95%CI: 1.09-3.95) were independent risk factors for abdominal lymph node metastases of pancreatic cancer.Conclusions Lymph node metastasis is an important factor affecting the prognosis of pancreatic cancer patients, while elevated preoperative CA19-9 level and low tumor differentiation are independent risk factors for lymph node metastasis of pancreatic

关 键 词：胰腺癌 胰十二指肠切除术 淋巴结转移 CA19-9 肿瘤分化 

分 类 号：R735.9[医药卫生—肿瘤]