胰腺癌术后肝转移的危险因素分析

Risk factors of liver metastasis in patients after radical resection of pancreatic cancer

目的分析影响胰腺癌术后肝转移的危险因素。方法回顾性分析2006年1月至2012年1月经手术切除原发灶、病理证实和完成随访的124例胰腺癌患者的临床病理资料。采用Logistic多因素分析影响胰腺癌术后肝转移的危险因素。结果124例胰腺癌根治术后发生肝转移48例（38．7％）。〈40岁、40～60岁、〉60岁患者的术后肝转移率分别为68．8％、33．3％和35．1％，身体质量指数（BMI）〈20kg／m^2、BMI20—25kg／m^2和BMI〉25kg／m^2患者的术后肝转移率分别为21．6％、44．1％和52．6％，发病确诊时间差≥3个月和〈3个月患者的术后肝转移率分别为59．4％和31．5％，术前合并和不合并脂肪肝患者的术后肝转移率分别为14．3％和43．7％，高分化、中分化、低分化患者的术后肝转移率分别为10．0％、35．4％和49．0％，脉管癌栓和无脉管癌栓患者的术后肝转移率分别为68．8％和34．3％，胰腺癌根治术后化疗和未行化疗患者的肝转移率分别为31．2％和51．1％，差异均有统计学意义（均P〈O．05）。单因素分析结果显示，年龄、BMI、发病确诊时间差、术前是否合并脂肪肝、组织学分级、浸润深度、脉管癌栓和术后化疗是影响胰腺癌术后肝转移的因素。Logistic多因素分析结果显示，BMI、发病确诊时间差、术前是否合并脂肪肝、组织学分级和脉管癌栓是影响胰腺癌术后肝转移的独立因素。结论术后胰腺癌患者的BMI、发病确诊时间差、组织学分级和脉管癌栓与肝转移有关。术前合并脂肪肝的胰腺癌患者术后不易发生肝转移。

Objective To analyze the risk factors of liver metastasis in patients after radical resection of pancreatic cancer. Methods One hundred and twenty-four patients with non-metastatic, resectable pancreatic cancer treated in our department between 2006 and 2012 were included in this study. All of these patients underwent resection of the primary tumor combined with extensive lymph node dissection. The development of postoperative liver metastases was carefully followed up, and the clinieopathological factors and molecular characteristics were evaluated by univariate analysis and multivariate logistic regression using SPSS 16.0 software. Results Forty-eight cases of liver metastases were found among the 124 cases of pancreatic cancer after radical surgery （38.7%）. The rate of liver metastasis of pancreatic cancer after radical surgery in the age groups 〈40, 40-60, and 〉60 were 68.8%, 33.3% and 35.1%, respectively. The rate of liver metastasis in the body mass index （BMI） group 〈20 kg/m^2, 20-25 kg/m^2, and 〉25 kg/m^2 were 21.6%, 44. 1% and 52.6%, and the rate of liver metastasis in the time between the onset and diagnosis groups ≥ 3 months and 〈3 months were 59.4% and 31.5%, respectively. The rate of liver metastasis in patients with preoperative fatty liver was 14.3% and it was 43.7% in patients without preoperative fatty liver. The rate of liver metastasis in patients of histological high, medium and low grade was 10.0%, 35.4% and 49.0%, respectively. The rate of liver metastasis in patients with venous tumor thrombus was 68.8% and it was 34.3% in patients without venous tumor embolus. The rate of liver metastasis in patients with postoperative chemotherapy was 31.2% and it was 51.1% in patients without postoperative chemotherapy. All those differences had statistical significance （P〈0.05）. Univariate analysis revealed that age, body mass index （BMI） , time between the onset and diagnosis, preoperative fatty liver, histological grading, tumor invasion depth, venous tumor embolus, and postoperative chemotherapy were significantly related to postoperative liver metastasis. Multivariate analysis revealed five statistically independent risk factors for postoperative liver metastasis： BMI, time between onset and diagnosis, preoperative fatty liver, histological grading, and venous tumor embolus. Conclusions Our data suggest that patient＇s BMI, time between onset and diagnosis, histological grade, and venous tumor embolus are significantly correlated with postoperative liver metastases in patients with pancreatic cancer. Pancreatic cancer patients with preoperative fatty liver have less postoperative liver metastasis.