胰腺癌肝转移497例多学科治疗临床分析

Multidisciplinary treatment and survival analysis for 497 cases of pancreatic cancer with liver metastases

目的 探讨胰腺癌肝转移（PCLM）的多学科治疗模式、临床疗效及预后因素.方法 回顾性分析了天津医科大学肿瘤医院2000年1月至2012年12月间经病理确诊并治疗的497例PCLM患者的临床特征、治疗方式与生存状况,随访至2015年6月30日.评价多学科治疗模式的疗效,分析预后相关因素.结果 患者的男女比例为1.85∶1,中位年龄59岁,同时性肝转移358例（72.0％）,合并肝外转移者173例（34.8％）.497例患者的0.5、1、3、5年生存率分别为44.1％、19.7％、3.2％和2.2％,中位生存期（MS）为5.4个月.基于手术、化疗、放疗、介入及物理治疗5种主要方式,接受3种以上治疗方式者疗效显著优于接受2种和1种者（MS：8.6个与5.2、4.6个月,P＜0.001）.对患者的临床特征与治疗方式进行多因素分析,有统计学意义的变量为：年龄、体重下降、腹水、患者功能状态（KPS）评分、胰腺肿瘤是否切除、白蛋白、CA 19-9、肝转移灶根治性手术、放疗及全身化疗.结论 PCLM为难治性恶性肿瘤,年龄＞60岁、3个月内体重下降≥10％、腹水、KPS评分＜80、白蛋白＜35 g/L、CA19-9≥500 U/ml提示预后不良,以胰腺癌和（或）肝转移灶根治性切除术、全身化疗及放疗为主的多学科综合治疗模式可有效改善患者预后,提高总体生存率.

Objective To explore the multidisciplinary therapeutic mode,clinical effect and prognostic factors of pancreatic cancer with liver metastases （PCLM）.Methods We retrospectively selected 497 consecutive patients with PCLM who were pathologically diagnosed and treated at Tianjin Medical University Cancer Hospital,from January,2000 to December,2012.Clinical characteristics,treatment modality,survival condition and factors associated with prognosis of these cases were analyzed,and efficacy of multidisciplinary treatment model was evaluated.Results Of these patients,the male/female ratio was 1.85∶ 1,with a median age of 59.A total of 358 （72.0%） cases had synchronous liver metastases,and 173 （34.8%） cases complicated with extrahepatic metastases.The 0.5,1,3,5 year survival rates of 497 patients were 44.1%,19.7%,3.2% and 2.2%,respectively,with a median survival （MS） of 5.4 months.Patients who were treated with 3 or more approaches （including surgery,chemotherapy,radiation therapy,interventional therapy,and physiotherapy） had a longer median survival time than patients treated with 2 or only 1 approach （MS：8.6 vs 5.2 vs 4.6 months,P 〈 0.001）.Multivariate analysis for clinical features and treatment modality showed that age,weight loss,ascites,karnofsky performance score （KPS）,primary site resection,albumin,carbohydrate antigen （CA） 19-9,resection of liver metastases,radiation therapy and systemic chemotherapy were prognostic variables with statistical significance.Conclusions PCLM is a refractory malignant tumor.Age 〉 60,weight loss （≥10% within 3 months）,ascites,KPS 〈 80,albumin 〈 35 g/L,and CA19-9 ≥500 U/ml were the most relevant predictors of poor survival.Multimodal treatment using curative resection of pancreatic cancer and/ or liver metastases,systemic chemotherapy and radiation therapy may improve the prognosis and survival rate sufficiently.