胰头癌切除术患者预后相关因素分析

Factors influencing survival of patients with cancer of the pancreatic head after resection

目的探讨影响胰头癌根治性切除术患者预后的相关因素，以期提高胰腺癌患者的生存率。方法回顾性分析1997年1月至2002年12月间住院的134例接受根治性切除（R0）手术的胰头癌患者，采用单因素及多因素Cox比例风险回归模型，分析影响胰头癌切除术后患者预后的相关因素。结果134例胰头癌患者中，47例（35．1％）行胰头十二指肠切除术，58例（43．3％）行扩大胰十二指肠切除术，29例（21．6％）行保留幽门的胰十二指肠切除术。有109例（81．3％）患者在观察期内出现复发，其中72例为腹膜后合并远处转移。134例患者术后平均生存期为24．7个月，1、3、5年生存率分别为67．1％、38．5％和17．6％。单因素分析显示，腰背部疼痛、CA19-9水平、肿瘤大小、淋巴结转移状况和血管受侵状况为影响预后的相关因素；多因素分析显示，腰背部疼痛、肿瘤直径〉2cm、淋巴结受侵及血管受侵是患者预后不佳的相关因素。结论胰头癌术后患者的预后与腰背部疼痛、肿瘤直径〉2cm、淋巴结受侵及血管受侵有关，这对胰腺癌手术预后判定和合理的外科治疗具有一定的临床指导意义。

Objective The aim of this cohort study was to investigate the clinical outcome and prognostic factors in patients after resection for ductal adenocarcinoma of the pancreatic head. Methods 134 patients with pancreatic head cancer undergoing curative resection （R0） between 1997 and 2002 were included in this study. Univariate and multivariate analyses were performed to examine factors affecting clinical outcome and recurrence of the cancer. Results Surgical procedures consisted of 58 （43.3%） extended pancreaticoduodenectomies （EPD）, 47 （35.1%） pancreaticoduodenectomies （PD） and 29 （21.6%） pylorus-preserving pancreaticoduodenectomies （PPPD）. The results showed that 81. 3% （109/134） of patients had a recurrence during the study period, mainly retroperitoneal combined with distant metastasis （53.7%）. The median postoperative survival time was 24.7 months. The 1-, 3- and 5-year overall survival rates for the study population were 67.1% , 38.5% and 17.6% , respectively. Univariate analysis showed that preoperative abdominal and/or back pain, tumor size 〉 2 cm, lymph node involvement and vascular invasion, and CA19-9 level were all significant predictors for poor survival. Multivariate analysis also showed that preoperative abdominal and/or back pain, tumor size 〉 2 cm, lymph node involvement and vascular invasion were all significant predictors for poor survival. Conclusion Our results suggest that preoperative abdominal and/or back pain, tumor size 〉 2 cm, lymph node involvement and vascular invasion are significant predictors for poor survival in patients with pancreatic head cancer.