壶腹癌患者胰十二指肠切除术后预后的影响因素分析

Analysis of Influencing Factors of Prognosis in Patients with Ampullary Carcinoma after Pancreaticoduodenectomy

目的探讨胰十二指肠切除术后影响壶腹癌患者预后的影响因素。方法回顾性分析212例壶腹癌患者临床资料,所有患者均于胰十二指肠切除术后随访36个月。根据随访结果将患者分为预后良好组(无瘤生存)和预后不良组(复发转移死亡)。记录所有患者随访结果并采用kaplan-meier法绘制生存曲线,比较两组一般资料及疾病相关因素,采用COX回归分析影响壶腹癌患者行胰十二指肠切除术预后的因素。结果①212例壶腹癌患者死亡76例,3年总生存率64.15%(136/212)。平均生存时间28.51个月;无瘤生存125例,局部复发61例、肝转移24例、2例癌症无关原因死亡,平均无病生存时间26.10个月;②预后良好组BMI<25 kg/m^2者、TNM分期Ⅰ期者、肿瘤<3 cm者、无淋巴结转移者、术后有辅助治疗者比例高于预后不良组(P<0.05),预后良好组NLR、PLR水平均低于预后不良组(P<0.05),两组性别、年龄、病理分化程度、术前CA199对比差异无统计学意义(P>0.05);③COX回归分析显示:NLR是影响壶腹癌行胰十二指肠切除术后预后的独立危险因素(P<0.05),TNM分期和无淋巴结转移是影响壶腹癌行十二指肠切除术后预后的保护因素(P<0.05)。结论NLR、TNM分期和淋巴结转移状态是胰十二指肠切除术后影响壶腹癌患者预后的重要因素。

Objective To explore the influencing factors of prognosis in patients with ampullary carcinoma after pancreaticoduodenectomy.Methods The clinical data of 212 patients with ampullary carcinoma were retrospectively analyzed.All patients were followed up for 36 months after pancreaticoduodenectomy.Patients were divided into good prognosis group(disease free survival)and poor prognosis group(recurrence,metastasis and death)according to the follow-up results.The follow-up results of all patients were recorded and the survival curves were drawn by kaplan-meier method.The general data and disease-related factors were compared between the 2 groups.COX regression analysis was used to analyze the factors of prognosis of patients with ampullary carcinoma after pancreaticoduodenectomy.Results Among the 212 patients with ampullary carcinoma,there were76 dead cases,and the 3-year overall survival rate was 64.15%(136/212)and the average survival time was 28.51 months.There were 125 cases of disease-free survival,61 cases of local recurrence,24 cases of liver metastasis and 2 cases died of unrelated cancer causes,and the average disease-free survival time was 26.10 months.The proportions of patients with BMI<25 kg/m^2,TNM stage I,tumor<3 cm,no lymph node metastasis and postoperative adjuvant therapy in good prognosis group were higher than those in good prognosis group(P<0.05),and the levels of NLR and PLR in good prognosis group were lower than those in poor prognosis group(P<0.05),and there were no significant differences in the gender,age,pathological differentiation degree and preoperative CA199 between the 2 groups(P>0.05).COX regression analysis showed that NLR was an independent risk factor for the prognosis of ampullary carcinoma after pancreaticoduodenectomy(P<0.05),and TNM staging and no lymph node metastasis were protective factors for the prognosis of ampullary carcinoma after pancreaticoduodenectomy(P<0.05).Conclusion NLR,TNM staging and lymph node metastasis are important factors influencing the prognosis of patients with ampullary carcinoma after pancreaticoduodenectomy.