胰腺癌侵犯门静脉患者的手术预后评价及相关危险因素分析

Prognosis and related risk factors in patients who underwent surgical resection for pancreatic cancer with portal vein invasion

目的评价门静脉系统侵犯胰腺癌患者手术治疗的预后,并分析其预后的危险因素。方法回顾性分析首都医科大学附属北京朝阳医院肝胆外科2011年1月至2018年12月收治的66例伴有门静脉系统侵犯的胰腺癌患者资料,男性30例,女性36例,年龄范围35~81岁,平均年龄61.5岁。所有患者均接受联合血管切除重建的胰腺癌手术治疗。收集和分析患者病历资料并随访预后情况。Kaplan-Meier法绘制生存曲线,生存率比较采用log-rank检验。多因素Cox回归分析生存预后的危险因素。结果66例患者均顺利完成手术,无围手术期死亡患者,术后发生并发症19例,发生率为28.8%。截止随访结束,共65例(98.5%,65/66)患者获得随访。门静脉系统侵犯胰腺癌患者术后1、2、3年累积生存率分别为53.3%、30.4%、23.4%,中位生存时间为13个月。多因素分析显示,术前糖类抗原19-9>400 U/ml(RR=1.871,95%CI:1.123~3.117)和静脉侵犯全层(RR=1.713,95%CI:1.072~2.736)是门静脉系统侵犯胰腺癌患者生存预后的独立危险因素。分层分析,糖类抗原19-9水平越高,静脉侵犯深度越深,患者的预后越差。结论伴有门静脉系统侵犯的胰腺癌患者远期预后较差,术前糖类抗原19-9>400 U/ml和静脉侵犯全层是患者生存预后的独立危险因素。

ObjectiveTo evaluate the prognosis and related risk factors in patients who underwent surgical resection for pancreatic cancer with portal vein invasion.MethodsThe clinical data of 66 patients with pancreatic cancer with portal vein invasion who underwent pancreatic combined with vascular resection and reconstruction at the Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital Affiliated to Capital Medical University between January 2011 and December 2018 were retrospectively studied.There were 30 males and 36 females.Their age ranged from 35 years to 81 years,with a mean of 61.5 years.Post-operative survival outcomes were evaluated on follow-up,and the related risk factors for prognosis were analyzed.Kaplan-Meier method was used to construct survival curves,and the survival rates were compared by the log-rank test.Multivariate Cox regression was used to analyze prognostic factors.ResultsAll 66 patients successfully underwent the operations.There was no perioperative death.The postoperative complication rate was 28.8%(19/66).Sixty-five patients were followed up(follow-up rate 98.5%,65/66).The overall 1-,2-and 3-year survival rates were 53.3%,30.4%,23.4%,respectively,with a median survival of 13 months.Multivariate analysis showed that preoperative CA19-9>400 U/ml(RR=1.871,95%CI:1.123-3.117)and depth of venous invasion(RR=1.713,95%CI:1.072-2.736)were independent risk factors of prognosis.The higher the preoperative CA19-9,and the deeper the venous invasion,the worse was the prognosis.ConclusionLong-term prognosis of pancreatic carcinoma patients with portal vein invasion was poor.Preoperative CA19-9>400 U/ml and depth of vascular invasion were the main risk factors of prognosis for patients with pancreatic carcinoma and portal vein invasion after surgical resection.