壶腹周围癌预后相关危险因素分析

Analysis of prognostic related risk factors in periampullary carcinoma

目的研究壶腹周围癌的临床病理因素与预后的相关性。方法回顾性分析2005年2月至2009年12月在复旦大学附属中山医院行胰十二指肠切除术的48例壶腹周围癌病人的临床病理资料与术后生存情况。采用寿命表法计算壶腹周围癌1年及3年累积存活率及中位生存时间,用Kaplan-Meier方法比较壶腹周围癌与同期随访的117例胰腺癌的生存情况及壶腹周围癌单因素生存分析,Cox比例风险模型进行壶腹周围癌多因素生存分析。结果 48例壶腹周围癌15例死亡,33例存活,1年及3年累积存活率分别为75%和55%,中位生存时间30个月;同期随访的117例胰腺癌病人,89例死亡,29例存活,1年及3年累积存活率分别为59%和42%,中位生存时间14个月。单因素生存分析示壶腹周围癌起源部位、淋巴结转移、神经侵犯与预后显著相关(P<0.05);而分化程度、脉管转移与预后无关。多因素生存分析示壶腹周围癌起源部位、淋巴结转移是两个预后的独立因素。结论壶腹周围癌预后明显好于胰腺癌;壶腹周围癌起源部位、淋巴结转移与预后密切相关。

Objective To analyze the correlation between clinicopathological features and prognosis of periampullary carcinoma. Methods The clinicopathological features and prognosis-related factors of 48 cases of periampullary carcinoma performed pancreaticoduodenectomy between February 2005 and December 2009 at Zhongshan Hospital of Fudan University were analyzed retrospectively. One-year and three-year cumulative survival rate and median survival time were calculated using life tables. Prognosis-related factors between 48 cases of periampullary carcinoma and 117 cases of pancreatic cancer followed up in the same period were compared by Kaplan-Meier method. Univariate and multivariate analysis was performed by Kaplan-Meier method and Cox Proportional Hazard Model respectively. Results Among 48 cases of periampullary carcinoma, 15 cases died and 33 cases survived. One-year and three-year cumulative survival rate was 75% and 55% respectively. The median survival time was 30 months. Among 117 cases of pancreatic carcinoma during the same follow-up period, 89 cases died and 28 cases survived. One-year and three-year cumulative survival rate was 59% and 42% respectively. The median survival time was 14 months. Univariate survival analysis revealed that tumor site, lymphatic metastasis and neural invasion were prognostic factors （P〈O.05）, while differentiation grade and vessel invasion were not. Multivariate survival analysis revealed that tumor site and lymphatic metastasis were two independent prognostic factors. Conclusion The prognosis of periampullary carcinoma is better than that of pancreatic carcinoma. Tumor site and lymphatic metastasis are two independent prognostic factors.