胰腺癌长期生存病人临床病理特征及生存质量研究

Clinicopathological characteristics and quality of life in long-term survival pancreatic cancer patients

目的通过分析长期生存胰腺癌病人(>5年)的临床病理特征,评价长期生存病人的健康相关生活质量。方法回顾性分析2005年1月至2014年9月于海军军医大学附属长海医院肝胆胰脾外科行手术切除的胰腺癌病人资料,选取有完整临床病理信息、随访>5年并存活的病人112例,对其生活质量进行评估,使用卡方检验进行组间资料比较,Mann-Whitney U检验及Kruskal-Wallis检验进行生存质量分析,探讨长期生存病人生存质量的影响因素。结果长期生存病人中,男性73例(65.2%),女性39例(34.8%),男女比例约为1.87∶1;年龄31~81岁,中位年龄61岁;行胰十二指肠切除术81例(77.3%),远端胰腺切除术31例(27.7%);肿瘤大小范围为0.5~7.0cm(中位值3.0 cm);高分化4例(3.6%),中分化74例(66.1%),低分化34例(30.4%);淋巴结阳性23例(20.6%),胰周神经侵犯56例(50%)。ⅠA期病人23例(20.5%),ⅠB期病人47例(42.0%),ⅡA期病人16例(14.3%),ⅡB期病人15例(13.4%),Ⅲ期病人8例(7.1%),Ⅳ期病人3例(2.7%)。获得完整生存质量量表的病人58例,功能量表得分四分位间距80~100分,症状量表得分以疲倦、疼痛、腹泻为主,总体健康状况(QOL)中位数为71.7分,四分位间距66.7~77.0分。女性病人疼痛得分高(P<0.05),术中输血的病人角色得分较高(P<0.05),无淋巴结转移(N0)的病人角色功能得分高且气促症状较轻(P<0.05);AB血型病人角色功能得分差(P<0.05)。肿瘤位置、手术方式、T分期、生存时间(年)、术后辅助化疗对生存质量的影响差异无统计学意义。行标准胰十二指肠切除术病人角色功能优于保留幽门的胰十二指肠切除病人(P=0.031)。结论胰腺癌长期生存病人临床病理因素差异巨大,术后长期生存病人拥有较高的生存质量。

Objective To analyze the clinicopathological characteristics of patients with long-term survival of pancreatic cancer(>5 years),and evaluate health-related quality of life.MethodsFrom January 2005 to September2014,112 patients with pancreatic cancer who underwent pancreatic surgery in Department of Hepatobiliopancreatic Surgery, Changhai Hospital, Naval Military Medical University were selected with complete clinical and pathological information. They were followed up for more than five years and survived. Chi-square test was used to compare data between groups, and Mann-Whitney U test and Kruskal-Wallis test were used to analyze the influencing factors of longterm survival patients’ quality of life.ResultsAmong the long-term survival patients,73(65.2%)were male and 39(34.8%)were female. The ratio of male to female was 1.87:1 approximately;the ages ranged from 31 to 81 with a median age of 61 years;81 cases(77.3%)were performed pancreaticoduodenectomy and the other 31 cases(27.7%)were performed distal pancreatectomy;tumor size ranged from 0.5 to 7.0 cm(median 3.0 cm);4 cases(3.6%)were high differentiation,74 cases(66.1%)were moderately differentiated and 34 cases(30.4%) were differentiated poorly;lymph nodes in 23 cases(20.6%)were positive,and 56 cases(50%)had perineural invasion. Twenty-three patients (20.5%)were with stage IA,47 patients(42.0%)with stage IB,16 patients(14.3%)with stage IIA,15 patients(13.4%)with stage IIB,8 patients(7.1%)with stage Ⅲ,and 3 patients(2.7%)with stage Ⅳ. Fifty-eight patients obtained a complete quality of life scale. The functional scale scores ranged from 80 to 100 in the interquartile range. The symptoms scale score was mainly fatigue,pain,and diarrhea. The median overall health status(QOL)was 71.7 points. The interquartile range was 66.7 to 77.0. Female patients had high pain scores(P<0.05);patients with blood transfusion had higher role scores(P<0.05)and patients without lymph node metastasis(N0)had high role function scores and less shortness of breath symptoms(P<0.05);patients with AB blood group had poor function scores(P<0.05). There was no significant difference in the effects of tumor location,surgical method,T stage,survival time and postoperative adjuvant chemotherapy on quality of life. Patients with standard pancreaticoduodenectomy performed better function than those with pyloru-perserverd(P=0.031).ConclusionClinicopathological factors in patients with long-term survival of pancreatic cancer vary widely,and patients with long-term survival after surgery have a higher quality of life.