辅助化疗在预防胰腺导管腺癌术后早期复发中的应用价值

Application value of adjuvant chemotherapy in preventing early recurrence of pancreatic ductal adenocarcinoma after surgery

目的探讨辅助化疗在预防胰腺导管腺癌(PDAC)术后早期复发中的应用价值。方法回顾性分析2011年1月至2014年12月在盘锦辽油宝石花医院收治的132例PDAC患者临床资料。其中男79例,女53例;年龄42~81岁,中位年龄66岁。患者均签署知情同意书,符合医学伦理学规定。根据术后早期6个月内有无复发,将患者分为早期复发组和非早期复发组。根据治疗方式不同将患者分为单纯手术组、术前化疗组、术后化疗组、术前+术后化疗组。早期复发相关因素及不同治疗模式对复发的影响分析采用χ^(2)检验。结果58例接受术前新辅助化疗,98例接受术后辅助化疗。早期复发39例,其中局部复发17例,远处转移22例。影响因素分析显示,TNM分期、术前CA19-9水平、术前新辅助化疗、肿瘤大小、术后并发症、术后辅助化疗与术后早期复发相关(χ^(2)=6.752,5.088,5.563,4.404,4.320,4.672;P<0.05)。术前+术后化疗组早期局部复发率明显低于单纯手术组(χ^(2)=5.834,P<0.016)。术后化疗组和术前+术后化疗组早期远处转移发生率明显低于单纯手术组(χ^(2)=8.532,8.210;P<0.017),亦明显低于术前化疗组(χ^(2)=6.842,6.729;P<0.017)。结论PDAC术后早期复发与肿瘤TNM分期、CA19-9水平及辅助化疗有关,术前新辅助化疗联合术后辅助化疗可预防PDAC术后早期局部复发和远处转移。

Objective To investigate the application value of adjuvant chemotherapy in preventing early recurrence of pancreatic ductal adenocarcinoma(PDAC)after surgery.Methods Clinical data of 132 PDAC patients admitted to Panjin Liaoyou Baoshihua Hospital from January 2011 to December 2014 were retrospectively analyzed.Among them,79 patients were male and 53 female,aged from 42 to 81 years,with a median age of 66 years.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into early recurrence group and nonearly recurrence group according to whether PDAC recurred within 6 months after surgery.All patients were divided into the single surgery,preoperative chemotherapy,postoperative chemotherapy,pre-and postoperative chemotherapy groups according to different treatment methods.The impact factors related to early recurrence,and the impact of different treatment patterns on the recurrence were analyzed by Chi-square test.Results 58 patients received preoperative neoadjuvant chemotherapy and 98 cases received postoperative adjuvant chemotherapy.Early recurrence occurred in 39 cases,including 17 cases of local recurrence and 22 cases of distant metastasis.The analysis result showed that TNM stage,preoperative CA19-9 level,preoperative neoadjuvant chemotherapy,tumor size,postoperative complications and postoperative adjuvant chemotherapy were significantly correlated with early postoperative recurrence(χ^(2)=6.752,5.088,5.563,4.404,4.320,4.672;P<0.05).The early local recurrence rate in the pre-and postoperative chemotherapy group was significantly lower than that in the single surgery group(χ^(2)=5.834,P=0.016).The early distant metastasis rates in the postoperative chemotherapy group,pre-and postoperative chemotherapy group were significantly lower than those in single surgery group(χ^(2)=8.532,8.210;P<0.017),and significantly lower compared with that in the preoperative chemotherapy group(χ^(2)=6.842,6.729;P<0.017).Conclusions Early postoperative recurrence of PDAC is associated with tumor TNM stage,CA19-9 level and adjuvant chemotherapy.Preoperative neoadjuvant chemotherapy combined with postoperative adjuvant chemotherapy can prevent the early postoperative local recurrence and distant metastasis of PDAC.