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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 331 -335. doi: 10.3877/cma.j.issn.1674-0793.2021.05.003

论著

胰头癌患者术后预后评价及相关危险因素分析
徐俊明1, 张欣雪1, 曹爽1, 刘喆1, 马军1, 寇建涛1, 贺强1,†()   
  1. 1. 100020　首都医科大学附属北京朝阳医院肝胆外科
  • 收稿日期:2021-05-13 出版日期:2021-09-28
  • 通信作者: 贺强

Evaluation of postoperative prognosis and related risk factors in patients with pancreatic head cancer

Junming Xu1, Xinxue Zhang1, Shuang Cao1, Zhe Liu1, Jun Ma1, Jiantao Kou1, Qiang He1,†()   

  1. 1. Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China
  • Received:2021-05-13 Published:2021-09-28
  • Corresponding author: Qiang He
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引用本文：

徐俊明, 张欣雪, 曹爽, 刘喆, 马军, 寇建涛, 贺强. 胰头癌患者术后预后评价及相关危险因素分析[J/OL]. 中华普通外科学文献(电子版), 2021, 15(05): 331-335.

Junming Xu, Xinxue Zhang, Shuang Cao, Zhe Liu, Jun Ma, Jiantao Kou, Qiang He. Evaluation of postoperative prognosis and related risk factors in patients with pancreatic head cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(05): 331-335.

目的

评价胰头癌患者行根治性手术的预后情况，并分析影响预后的相关因素，为提高胰头癌患者生存率提供借鉴。

方法

回顾性分析首都医科大学附属北京朝阳医院2015年1月至2019年12月连续收治的167例可切除或交界可切除胰头癌患者的临床资料及随访情况，采用Kaplan-Meier法绘制生存曲线，生存率比较采用Log-rank检验，多因素Cox回归分析预后影响因素，以X-tile软件计算淋巴结参数的最佳截断值。

结果

167例患者均顺利完成手术，其中围手术期死亡2例（1.2%），其余患者均获随访。术后总体中位生存时间17个月，1、2、3年总体生存率分别为59.3%、36.5%、25.2%。肿瘤低分化（HR=1.708，95% CI：1.147~2.543）和淋巴结阳性率>0.1（HR=2.029，95% CI：1.069~3.853）是影响胰头癌患者预后的独立危险因素。

结论

胰头癌患者行根治性手术预后较好。肿瘤分化程度越低、淋巴结阳性率越高的胰头癌患者预后越差，淋巴结阳性率对于预后的预测优于单纯的淋巴结阳性数。

关键词: 胰头肿瘤, 胰十二指肠切除术, TNM分期, 淋巴结清扫, 淋巴结阳性率, 肿瘤分化, 预后
Objective

To evaluate the prognosis of patients with pancreatic head cancer undergoing radical surgery, and to analyze the related factors affecting the prognosis, in order to provide reference for improving the survival rate.

Methods

The clinical data and follow-up of 167 patients with resectable or borderline resectable pancreatic head cancer admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2015 to December 2019 were retrospectively analyzed. Kaplan-Meier method plotted the survival curve, Log-rank test was used for survival comparison, Multivariate Cox regression was used to analyze the prognostic factors, and the best cut-off value of lymph node parameters was calculated by X-tile software.

Results

All the patients successfully completed the operation, 2 cases (1.2%) died during the perioperative period, and the other patients were followed up. The overall median survival time was 17 months. The 1-, 2- and 3-year overall survival rates were 59.3%, 36.5% and 25.2% respectively. Low tumor differentiation (HR=1.708, 95% CI: 1.147-2.543) and lymph node positive rate > 0.1 (HR=2.029, 95% CI: 1.069-3.853) were independent risk factors affecting the prognosis of patients with pancreatic head cancer.

Conclusions

The prognosis of patients with pancreatic head cancer undergoing radical surgery is better. The lower the degree of tumor differentiation and the higher the positive rate of lymph nodes, the worse the prognosis. Moreover, the predictive value of lymph node positive rate for prognosis is better than that of lymph node positive number.

Key words: Pancreatic head carcinoma, Pancreatoduodenectomy, TNM classification, Lymph node dissection, Lymph node positive rate, Tumor differentiation, Prognosis
图1 胰头癌患者术后总体生存曲线
表1 影响根治性胰十二指肠切除胰头癌患者预后的单因素分析(%)
因素 例数 1年生存率 2年生存率 3年生存率 χ2值 P值
性别         4.194 0.041
  男 92 54.0 26.7 19.0    
  女 75 59.0 44.4 30.0    
年龄(岁)         0.282 0.595
  ≤60 63 65.9 40.4 24.9    
  >60 104 50.3 30.9 24.1    
症状         0.405 0.525
  有 142 68.0 47.7 26.5    
  无 25 54.1 32.1 23.4    
吸烟史         3.004 0.083
  有 50 53.6 21.2 12.3    
  无 117 57.5 40.5 29.0    
糖尿病史         0.384 0.535
  有 54 61.0 35.3 24.2    
  无 113 54.2 34.4 24.0    
AST(U/L)         0.151 0.697
  ≤35 61 59.8 33.7 28.6    
  >35 106 54.3 35.4 21.4    
ALT(U/L)         0.151 0.697
  ≤40 61 59.6 33.0 27.7    
  >40 106 54.5 35.7 22.1    
ALB(g/L)         3.902 0.048
  ≥40 35 63.6 49.4 27.8    
  <40 132 54.5 31.4 23.4    
TBIL(μmol/L)         1.378 0.240
  ≥21 110 55.7 34.6 23.0    
  <21 57 57.9 34.8 27.4    
CEA(μg/L)         7.706 0.006
  ≤5 126 62.3 39.5 28.9    
  >5 41 39.0 20.7 10.6    
CA19-9(U/ml)         3.964 0.046
  ≤37 32 60.5 48.5 43.1    
  >37 135 55.3 31.7 20.9    
术前减黄         1.729 0.189
  是 43 49.4 31.4 26.9    
  否 124 58.5 35.7 23.8    
肿瘤分化程度         4.846 0.028
  低 57 41.8 22.1 16.8    
  中-高 110 67.5 43.4 29.2    
静脉侵犯         1.385 0.239
  有 82 50 32.9 21.5    
  无 85 62.4 36.9 27.1    
T分期         6.712 0.035
  T1 35 75.1 57.9 37.2    
  T2 99 56.2 32.0 23.7    
  T3 33 37.9 19.0 12.6    
淋巴结清扫数(个)         0.166 0.684
  <29 119 57.0 36.3 23.1    
  ≥29 48 54.5 30.0 26.7    
淋巴结阳性数(个)         17.491 <0.001
  0 50 76.7 55.7 39.6    
  1~2 46 61.9 44.0 31.0    
  ≥3 71 38.7 13.5 9.0    
N分期         15.107 0.001
  N0 50 76.7 55.7 39.6    
  N1 64 54.7 37.8 25.6    
  N2 53 39.6 11.5 8.6    
淋巴结阳性率         21.607 <0.001
  0 50 76.7 55.7 39.6    
  <0.1 40 69.4 53.9 27.3    
  ≥0.1 77 36.9 13.6 7.8    
表2 影响根治性胰十二指肠切除胰头癌患者预后的Cox回归分析
因素 HR值 95% CI P值
性别 1.250 0.852~1.835 0.255
术前白蛋白 0.725 0.434~1.211 0.219
术前CEA 1.361 0.889~2.083 0.157
术前CA19-9 0.936 0.553~1.584 0.806
肿瘤分化程度 1.708 1.147~2.543 0.008
T分期 1.350 0.982~1.857 0.064
N分期 0.822 0.428~1.577 0.555
淋巴结阳性数 1.612 0.825~3.151 0.162
淋巴结阳性率 2.029 1.069~3.853 0.031
图2 不同分化程度胰头癌患者根治术后的生存曲线
图3 不同淋巴结阳性率胰头癌患者根治术后的生存曲线
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