胰腺体尾部导管腺癌生存预后的影响因素分析  

Analysis of Prognostic Factors in Patients With Pancreatic Ductal Adenocarcinoma of the Body and Tail

作　　者：袁静雅 修典荣[1] Yuan Jingya;Xiu Dianrong(Department of General Surgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院普通外科,北京100191

出　　处：《中国微创外科杂志》2023年第3期161-166,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨影响胰体尾癌患者生存预后的临床病理因素。方法回顾性收集2010年1月~2021年11月112例胰体尾癌根治术的胰腺导管腺癌患者的临床病理资料,采用Cox比例风险回归模型进行单因素及多因素分析筛选与生存预后相关的临床病理特征。结果112例中,术后病理可见脉管浸润36例,神经浸润94例。术后中位生存时间19个月,1年、3年、5年生存率分别为67.3%、27.4%、14.7%。单因素分析显示,更高的pT分期、TNM分期、淋巴结转移及脉管浸润等病理特征,以及术前CA19-9水平、术后1个月CA19-9水平、手术方式、术中出血量、联合血管切除以及术后辅助化疗等临床特征,与胰体尾癌患者的生存预后相关(P<0.05)。多因素分析结果显示,脉管浸润(HR=1.938,95%CI:1.173~3.201,P=0.010),更高的TNM分期(HR=2.133,95%CI:1.045~4.353,P=0.037),术后CA19-9高(HR=2.349,95%CI:1.431~3.855,P=0.001),联合血管切除(HR=2.352,95%CI:1.229~4.504,P=0.010),术中出血量>150 ml(HR=2.064,95%CI:1.210~3.523,P=0.008)以及未接受术后辅助化疗(HR=2.017,95%CI:1.237~3.287,P=0.005)是影响胰体尾癌患者生存的独立预后因素。结论术中出血量、联合血管切除、术后CA19-9水平、术后辅助化疗、脉管浸润及TNM分期是影响胰体尾癌患者生存的独立预后因素。Objective To investigate the clinicopathological factors that affect the survival prognosis of pancreatic ductal adenocarcinoma(PDAC)of the body and tail.Methods The clinicopathological data of 112 patients with PDAC of the body and tail undergoing radical distal pancreatectomy from January 2010 to November 2021 were collected retrospectively.The Cox proportional-hazard regression model was used for univariate and multivariate analysis to select the clinicopathological features related to survival prognosis.Results Among the 112 patients,lymphovascular invasion and perineural invasion were identified in 36 and 94 patients,respectively.The median survival time was 19 months,and the 1-,3-,5-year survival rates were 67.3%,27.4%and 14.7%,respectively.In univariate analysis,pathological features such as higher pT stage,TNM stage,lymphnode metastasis and lymphovascular invasion,clinical characteristics such as preoperative CA19-9 level,1-month postoperative CA19-9 level,surgical method,intraoperative blood loss,combination with vascular resection,and postoperative chemotherapy were related to the survival prognosis of patients with PDAC of the body and tail(all P<0.05).In multivariate analysis,lymphovascular invasion(HR=1.938,95%CI:1.173-3.201,P=0.010),higher TNM stage(HR=2.133,95%CI:1.045-4.353,P=0.037),higher postoperative CA19-9 level(HR=2.349,95%CI:1.431-3.855,P=0.001),combination with vascular resection(HR=2.352,95%CI:1.229-4.504,P=0.010),intraoperative blood loss>150 ml(HR=2.064,95%CI:1.210-3.523,P=0.008),and without postoperative chemotherapy(HR=2.017,95%CI:1.237~3.287,P=0.005)were the independent survival prognostic factors in patients with pancreatic body and tail adenocarcinoma.Conclusion Intraoperative blood loss,combination with vascular resection,postoperative CA19-9 level,postoperative adjuvant chemotherapy,vascular infiltration and TNM stage are independent prognostic factors in patients with pancreatic body and tail adenocarcinoma.

关 键 词：胰腺导管腺癌 预后 影响因素 

分 类 号：R735.9[医药卫生—肿瘤]