综合治疗在预后不良胰腺癌中的价值

Value of combined therapy in pancreatic cancer with a poor prognosis ： analysis of 233 clinical cases

目的探讨综合治疗在预后不良胰腺癌中的价值。方法回顾性分析233例病理或细胞学证实的胰腺癌在不同临床病理因素和治疗方式下的生存状况。结果（1）胰腺癌患者的生存期与消瘦、腰背疼痛、糖链抗原19-9（CA19-9）数值和肿瘤的分期有关，差异均有统计学意义。如出现消瘦、腰背疼痛、CA19—9〉37U／ml和TNM分期为Ⅲ期和Ⅳ期的患者定义为预后不良组。（2）根据对肿瘤的治疗状况，将患者分为胰腺肿瘤切除组，姑息性治疗组（包括术中^125I放射性粒子或氟尿嘧啶植入剂植入、全身化疗、外照射放射治疗和介入化疗），未针对肿瘤治疗组（包括单纯探查、内引流和营养支持的患者），患者的中位生存期分别为14．0、8．3、6．6个月；1年生存率分别为53．5％、22．5％、11．8％，5年生存率分别为5．8％、0、0（3）分析预后不良组病例，在出现消瘦、腰背疼痛、CA19-9〉37U／ml和TNM分期为Ⅲ期和Ⅳ期的患者中，胰腺肿瘤切除组的中位生存期分别12．0、11．0、12．0、7．0个月，姑息性治疗组的中位生存期分别为7．7、7．5、8．6和8．0个月，未针对胰腺癌治疗组的中位生存期分别为4．0、3．0、4．0和4．6个月。结论积极合理地开展综合治疗，有助于改善预后不良组胰腺癌患者的预后。

Objective To analyze the value of combined therapy in pancreatic cancer with a poor prognosis. Methods The prognostic factors of pancreatic cancer with different clinicopathological chacteristics and treatment modalities were analyzed retrospectively and the cumulative curve was plotted using the Kaplan-Meier method. Results （ 1 ） From January 2001 to December 2005, 233 patients with pathological and cytological diagnosis of pancreatic cancer were analyzed. The median survival of all patients was 8.67 months, the 1-year survival rate 29. 6% and the 5-year survival rate 4. 5%. （2） Weightloss cases had a median survival of 7.7 months versus 10. 0 months for cases without weightloss （ P = 0. 003 ）. Back pain cases had a median survival of 6. 5 months versus 9. 0 months for cases without back pain （ P = 0. 015）. Cases with normal CA19-9 levels （ ≤37 U/ml） had a median survival of 11.0 months versus 8.0 months for cases with CA19-9 〉 37 U/ml levels （ P = 0. 000 ）. Stages III and IV disease cases had a median survival of 8.7 and 6. 3 months versus 16. 0 months for cases of Stages I ＋ II （P =0. 000）. In the present study, patients suffering from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV were defined as cases with a poor prognosis. （3）Patients were grouped as pancreatectomy group, cancer-directed treatment goup （including intraoperative iodine-125 seed interstitial brachytherapy, 5-FU interstitial chemotherapy, radiotherapy, chemotherapy and transcatheter arterial infusion chemotherapy ） and no cancer-directed treatment group （including cases receiving biopsies or bypass）. Median survival of three groups were 14. 0, 8.3 and 6. 6 months respectively. And the 1-year survival rates were 53.5% , 22. 5% and 11.8% respectively while the 5-year survival rate 5.8% , 0 and 0 respectively. （4）Median survival of poor prognostic cases （who suffered from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV） treated with pancreatectomy were 12.0, 11.0, 12.0 and 7.0 months respectively. Median survival of poor prognostic cases treated with cancerdirected therapy were 7.7, 7.5, 8.6 and 8.0 months respectively. Median survival of poor prognostic cases treated with no cancer-directed therapy were 4. 0, 3. 0, 4. 0 and 4. 6 months respectively. Conclusion Optimized combined therapy is recommended for pancreatic cancer patients with poor prognostic factors.