根治性切除胰头癌患者临床病理资料与预后的关系

Relation Between Clinicopathologic Factors and Prognosis of Pancreatic Head Cancer Following Radical Resection

目的探讨根治性切除胰头癌患者的临床病理因素与预后的关系。方法回顾性分析兰州军区乌鲁木齐总医院2000年1月1日至2007年12月1日期间38例行根治性手术的原发性胰头癌患者的临床病理资料,采用SPSS 17.0软件进行统计学处理,分析临床病理特征间的相关性及其与预后的关系。结果 1本组38例胰头癌患者中有31例获得随访,随访率为81.6%,1年累积生存率为38.7%,2年累积生存率为12.9%。2 Spearman相关性分析各临床病理因素的关系发现,远处转移与肿瘤大小(rs=0.421,P=0.008)及TNM分期(rs=0.746,P=0.000)有关,淋巴结转移与TNM分期有关(rs=0.543,P=0.001),肿瘤大小也与TNM分期有关(rs=0.475,P=0.003)。3单因素分析影响胰头癌患者预后的临床病理因素结果表明,性别(P=0.045)、肿瘤大小(P=0.004)、分化程度(P=0.003)、TNM分期(P=0.000)、远处转移(P=0.002)及淋巴结转移(P=0.001)与胰头癌根治性手术后的预后有关,进一步多因素分析结果表明,TNM分期(P=0.001)、分化程度(P=0.003)及淋巴结转移(P=0.007)为胰头癌根治性手术后患者的预后影响因素。4 Kaplan-Meier法分析生存率的结果显示,中、高分化患者预后明显优于低分化患者(χ2=11.356,P=0.003);TNMⅠ+Ⅱ期患者的预后明显好于Ⅲ+Ⅳ期患者(χ2=15.970,P=0.000);无远处转移患者的预后明显好于有远处转移患者(χ2=9.248,P=0.002);无淋巴结转移患者的的预后明显好于有淋巴结转移患者(χ2=10.144,P=0.001)。结论淋巴结转移与TNM分期关系密切,而与分化程度无明显相关性;淋巴结转移、分化程度及TNM分期为胰头癌根治性手术后患者的预后影响因素。

Objective To investigate the correlation with clinicopathologic factors and prognosis in pancreatic head cancer following radical resection. Methods Thirteen-eight patients with primary pancreatic head cancer admitted into Urumuqi General Hospital of Lanzhou Military Region from January 2000 to December 2007 were treated by radical resection, the clinicopathologic factors were retrospectively analyzed, the SPSS 17. 0 analysis software was used to analyze the relation between clinicopathologic factors and prognosis. Results OThe follow-up rate was 81.6% （31/38）, the 1- and 2-year overall survival was 38.7% and 12.9%, respectively. （~） Spearman analysis showed that the distant metastasis was significantly correlated with the tumor size （rs=0. 421, P=0. 008） and TNM stage （rs=0. 746, P=0. 000） ; the lymph node metastasis was significantly correlated with TNM stage （rs=0. 543, P=0. 001） and was not correlated with tumor differentiation degree （rs=0. 074, P=0. 695）, the tumor size was also significantly correlated with TNM stage （rs=0. 475, P=0. 003）. （3）Univariate Chi-Square test revealed that the gender （P=-0. 045）, tumor size （P=0. 004）, tumor differentiation degree （P=0. 003）, TNM stage （P=-0. 000）, distant metastasis （P=-0. 002）, and lymph node metastasis （P=- 0. 001） were correlated with the prognosis of pancreatic head cancer. However, when the interactive effects of those factors were taken into account, TNM stage （P=0. 001）, differentiation degree （P=-0. 003）, and lymph node metastasis （P=-0. 007） were selected as the most significant prognostic factors in a multivariate analysis by using the Cox proportional hazard regression model. （4） The survival rate of patients with low differentiation degree was significantly shorter than that of moderate/high differentiation degree （P=-0. 003）, of patients with Ⅰ ＋Ⅱ stages was significantly longer than that of Ⅲ ＋Ⅳ stages （P=0. 000）, of patients with distant metastasis or lymph node metastasis was significantly lower than those patients without distant metastasis or lymph node metastasis （P=-0. 002, P=0. 001）. Conclusions The lymph node metastasis is significantly associated with TNM stage, and is not associated with differentiation degree. The lymph node metastasis, differentiation degree, and TNM stage are related with survival, and they are also independent prognostic factors of pancreatic head cancer.