门静脉狭窄在晚期不可切除胰腺癌中的研究  

Study of portal vein stenosis in advanced unresectable pancreatic cancer

作　　者：张杰[1] 张梦肃 张芳琴 金光鑫[2] 许晟熙 张学彬[2] ZHANG Jie;ZHANG Mengsu;ZHANG Fangqin;JIN Guangxin;XU Shengxi;ZHANG Xuebin(Shanghai Jiao Tong University of Medicine,Shanghai 200025;Department of Interventional Oncology,Renji Hospital,Shanghai Jiao Tong University of Medicine,China)

机构地区：[1]上海交通大学医学院,上海200025 [2]上海交通大学医学院附属仁济医院肿瘤介入科

出　　处：《胃肠病学和肝病学杂志》2025年第4期476-481,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：上海市科学技术委员会科技支撑项目(19441907000)。

摘　　要：目的研究晚期不可切除胰腺癌合并门静脉狭窄对患者总生存时间(overall survival,OS)的影响,并探讨相关预后因素,以为临床实践提供针对性的指导。方法回顾性分析2018年1月至2022年12月在上海交通大学医学院附属仁济医院接受治疗的164例未切除胰腺癌晚期患者的临床资料,根据是否存在门静脉狭窄将其分为门静脉狭窄组(n=64)和门静脉无狭窄组(n=100)。通过电话、住院复诊等手段进行随访。在处理观察性数据时,我们应用了逆处理概率加权(inverse probability treatment weighting,IPTW)方法,以控制基线偏差。OS的生存分析采用Kaplan-Meier方法,Log-rank检验用于比较各组生存结局,Cox比例风险模型用于进行多因素分析,比较两组患者的生存预后。结果门静脉狭窄组和门静脉无狭窄组的中位OS分别为403 d、528 d,差异有统计学意义(P=0.006)。门静脉狭窄组和门静脉无狭窄组1年的生存率分别为55%和70%。在单因素分析中,门静脉狭窄(P=0.006)、肝转移(P=0.021)和腹水(P=0.038)是生存预后的不良因素。多因素分析提示,门静脉狭窄、肝转移在考虑其他因素的情况下仍然显示为患者生存预后的不良因素。此外,化疗联合免疫治疗与晚期不可切除胰腺癌患者预后良好密切相关。亚组分析提示,无论患者肿瘤是否肝转移,门静脉狭窄患者的生存预后较差;未联合免疫治疗的化疗患者中,门静脉狭窄患者预后差,而化疗联合免疫的患者差异无统计学意义。此外,门静脉狭窄组的并发症,静脉曲张和黄疸相对较多于门静脉无狭窄组。结论门静脉狭窄对未切除的胰腺癌晚期患者的生存预后产生不良影响,临床实践中应予以高度重视。Objective To explore the impact of portal vein stenosis on overall survival(OS)in patients with unresectable advanced pancreatic cancer,in order to investigate relevant prognostic factors to provide targeted guidance for clinical practice.Methods We conducted a retrospective study of clinical data from 164 patients with unresectable advanced pancreatic cancer who were treated at Renji Hospital,Shanghai Jiao Tong University School of Medicine,from Jan.2018 to Dec.2022.Patients were categorized into two groups based on the presence or absence of portal vein stenosis(stenosis group:64 cases;non-stenosis group:100 cases).Follow-up was conducted through telephone interviews and hospital revisits.In handling observational data,the inverse probability treatment weighting(IPTW)method was applied to control baseline deviations.Kaplan-Meier survival analysis was used for OS,Log-rank test was used to compare the survival outcomes between groups,and Cox proportional hazards model was used for multivariate analysis to compare the survival prognosis of the two groups of patients.Results The median OS of the portal vein stenosis group was 403 days,while that of the non-stenosis group was 528 days,showing a statistically significant difference.The 1-year survival rate was approximately 55%in the stenosis group and 70%in the non-stenosis group.In the single-factor analysis,portal vein stenosis(P=0.006),liver metastasis(P=0.021),and ascites(P=0.038)were identified as adverse prognostic factors.The multivariate analysis suggested that portal vein stenosis and liver metastasis remained adverse prognostic factors for patient survival when considering other factors.Additionally,the combination of chemotherapy and immunotherapy was closely associated with a favorable prognosis in patients with unresectable advanced pancreatic cancer.Subgroup analysis indicated that regardless of whether the patient's tumor had liver metastasis,those with portal vein stenosis had a poorer prognosis.Among chemotherapy patients not receiving immunotherapy

关 键 词：门静脉狭窄 胰腺癌晚期 生存预后 

分 类 号：R735.9[医药卫生—肿瘤]