胰腺癌280例诊断与预后分析

Diagnosis and prognosis of 280 patients with pancreatic carcinoma

目的探讨影响胰腺癌早期诊断及生存预后的因素。方法收集2002年1月至2007年1月有完整随访资料的胰腺癌患者280例，对所有病例进行病史采集及随访。Kaplan—Meier及寿命表计算生存率，log—rank检验进行影响预后的单因素分析，符合条件的纳入Cox比例风险模型进行多因素分析。结果本组病例中，91．8％患者的年龄〉40岁，高峰年龄在50～73岁。多以腹痛和黄疸就诊。影像学检查以B超和CT为主，敏感性分别为70．6％、95．3％。89．3％患者联合进行B超和CT检查。CA19-9敏感性为81．1％。中位生存期为（7．0±0．5）个月，1～5年生存率分别为28％、9％、6％、2％、1％。单因素分析提示，年龄〉65岁、CA19-9〉均数、TNMⅢ或Ⅳ期、有淋巴结或血管浸润以及2个以上脏器转移、非手术治疗、KPS评分〈60分、体重下降≥5kg等都是预后不良的因素；Cox多因素分析结果表明，治疗方式、年龄、TNM分期、KPS评分和有无腹水是影响患者预后的独立危险因素。结论患者年龄、有无腹水、肿瘤分期及治疗方式是影响本组胰腺癌预后的高风险独立因素。早期诊断与治疗是提高胰腺癌患者生存时间的关键。

Objective To evaluate the factors influencing early diagnosis and prognosis in patients with pancreatic carcinoma. Methods The clinical data of 280 patients who had complete follow-up data with pancreatic carcinoma treated from January 2002 to January 2007 were reviewed retrospectively. The medical history and follow-up data were collected from all patients. Survival rate was calculated by the life table method and the Kaplan-Meier estimation. Log-rank test was used for univariate prognostic analysis and Cox regression was used for multivariate prognostic analysis. Results 91.8% of the patients were more than 40 years old and the peak age was 50 - 73 years old ; the major presentations were abdominal pain and jaundice. Major imaging tests included B-ultrasound and CT, the sensitivity was 70.6%, 95.3% , respectively; 89.3% of patients had combined B-ultrasound and CT examination. The sensitivity of CA19-9 was 81.1%. The median survival time was （7.0 - 0.5） months. Overall survival rates at 1 - 5 year survival rates were 28% , 9% , 6% , 2% , and 1%. Univariate analysis suggested that age 〉 65 years old, CA19-9 〉 mean value, TNM m or IV stage, lymph nodes invasion, vascular invasion, and metastasis of two or more organs, non-surgical treatment, KPS score 〈 60 points, weight loss ≥ 5 kg were poor prognostic factors; Cox multivariate analysis showed that treatment modalities, age, TNM stage, KPS score and ascites were independent risk factors for dismal prognosis. Conclusions The age, ascites, tumor stage and treatment modalities affected the prognosis of patients with pancreatic cancer. Early diagnosis and treatment was important to improve the survival time of patients with pancreatic cancer.