胰腺癌术后生存率的影响因素

The influencing factors of postoperative pancreatic cancer

目的:探讨影响胰腺癌术后生存率的影响因素。方法:回顾性分析2010年1月至2012年12月本院178例行胰十二指肠切除术治疗的胰腺癌患者(研究组)以及81例同期健康体检者(对照组)的临床资料,分析术后生存率的影响因素。单因素分析采用Logistic二元回归模型,筛选有统计学意义的指标纳入COX风险回归模型进行多因素分析。结果:Kaplan-Meier结果显示,178例患者术后1年、2年、3年总体生存率分别为56.2%、18.0%、1.7%。单因素分析结果表明,性别、年龄、肿瘤位置与术后生存率无相关性(P>0.05);而肿瘤大小、肿瘤分化程度、临床分期、淋巴结转移、肝转移、血清sPLA2-ⅡA、CD44v6、整合素β1和CA19-9水平与术后生存率有相关性(P<0.05)。COX多因素回归分析显示,临床分期、淋巴结转移、肝转移、血清sPLA2-ⅡA、CD44v6、整合素β1和CA19-9水平对患者术后生存率的影响差异有统计学意义(P<0.05),是影响术后生存率的独立危险因素。患者术前、术后1周血清sPLA2-ⅡA、CD44v6、整合素β1和CA19-9表达水平显著高于对照组(P<0.05),而术后1个月的表达水平与对照组差异均无统计学意义(P>0.05)。患者术后血清sPLA2-ⅡA、CD44v6、整合素β1和CA19-9表达水平均逐渐下降,术后1个月的表达水平均显著低于术前(P<0.05)。患者术后1个月sPLA2-ⅡA、CD44v6、CA19-9表达水平显著低于术后1周(P<0.05),整合素β1表达水平和术后1周差异无统计学意义(P>0.05)。sPLA2-ⅡA、CD44v6、整合素β1和CA19-9低表达患者的术后生存率均显著高于高表达的患者(P<0.05)。结论:在进行胰腺癌治疗时应特别注意临床分期、淋巴结转移、肝转移、血清sPLA2-ⅡA、CD44v6、整合素β1和CA19-9水平等影响预后的独立危险因素,以提高生存率。

Objective： Discussing the influence factors of postoperative pancreatic cancer survival rates. Methods：To retrospectively analyze 178 cases of pancreatic cancer with routine treatment of pancreaticoduodenal resection（ study group）,81 healthy people through physical examination（ control group） for the influence factors of postoperative survival rate. Factor analysis was made through binary Logistic regression model,and COX regression model. Results： Kaplan-Meier showed postoperative 1 year,2 years,3 years overall survival rates in 178 patients were 56. 2%,18. 0% and 1. 7% respectively. Single factor analysis showed that gender,age,tumor location had no impact on the postoperative survival rate（ P〉 0. 05）. Tumor size,differentiation,clinical stages,lymphatic metastasis,liver metastasis and serum sPLA2-ⅡA,CD44v6,integrin beta 1 and CA19-9 levels were associated with postoperative survival rate（ P 〈0. 05）. COX regression analysis showed that,clinical stages,lymphatic metastasis,liver metastasis,serum sPLA2-ⅡA,CD44v6,integrin beta 1 and CA19-9 level in patients were independent risk factors influencing the postoperative survival rate. In preoperation and postoperative 1 week serum sPLA2-ⅡA,CD44v6,integrin beta 1 and CA19-9 expression level were significantly higher than that of control（ P 〈0. 05）,and the expression level of postoperative 1 month had no statistically significant difference compared with the control group（ P〉 0. 05）. Postoperative serum sPLA2-ⅡA,CD44v6,integrin beta 1 and CA19-9 expression level were gradually declined,and postoperative 1 month expression levels were significantly lower than that of preoperation（ P〈 0. 05）. Postoperative 1 month sPLA2-ⅡA,CD44v6,CA19-9 expression level were significantly lower than postoperative 1 week（ P 〈0. 05）,and integrin beta 1 expression level had no statistically significant difference compared with postoperative 1 week（ P〉 0. 05）. The postoperative survival rate in sPLA2-ⅡA,CD44v6,integrin beta 1,CA19-9 low expression was significantly higher than that of high expression（ P 〈0. 05）. Conclusion： In order to improve the survival rate of pancreatic cancer,in the treatment,we should pay special attention to the clinical stages,lymphatic metastasis,liver metastasis,serum sPLA2-ⅡA,CD44v6,integrin beta 1 and CA19-9 levels which were independent risk factors affecting the prognosis.