十二指肠腺癌88例临床特征及相关预后因素

Clinical Features and Related Prognostic Factors of 88 Cases of Duodenal Adenocarcinoma

目的分析十二指肠腺癌患者的临床特征及相关预后因素。方法对云南省肿瘤医院2010年1月至2019年12月期间收治的经病理确诊的88例十二指肠腺癌患者进行回顾性研究。采用Kaplan-Meier法评估患者的生存状况,用Log-rank检验进行单因素分析,Cox比例风险回归模型进行多因素分析,从而筛选出影响十二指肠腺癌患者预后的相关危险因素。结果88例十二指肠腺癌患者的年龄范围:23~79岁,平均年龄为54.83岁,男女比例:1.44∶1。生存分析提示:十二指肠腺癌患者发生转移、无转移的中位生存时间分别为14个月、19个月,即发生转移较无转移者预后更差(P<0.05)。单因素分析显示:转移有无、原发灶直径、临床分期、化疗方案、化疗药物种类、手术方式、Hp感染、CEA、CA199、AST/ALT、NKC、PLT、LMR与十二指肠腺癌患者预后有关(P<0.05)。Cox多因素分析提示:发生转移、Hp(+)、CA199>27 U/mL是影响十二指肠腺癌患者预后的独立危险因素(P<0.05),而根治性手术是十二指肠腺癌患者预后的有益因素(P<0.05)。结论十二指肠腺癌发生转移则预后极差,需早期密切监测,临床上可用有无转移、手术方式、Hp感染、CA1994个指标预测患者预后。

Objective To analyze the clinical characteristics and related prognostic factors of patients with duodenal adenocarcinoma.Methods 88 patients with duodenal adenocarcinoma who were pathologically diagnosed and admitted to Yunnan Cancer Hospital from January 2010 to December 2019 were studied retrospectively.The Kaplan-Meier method was used to evaluate the survival status of patients,the Log-rank test was used for univariate analysis,and the Cox proportional hazard regression model was used for multivariate analysis to screen out the relevant risk factors affecting the prognosis of patients with duodenal adenocarcinoma.Results The age range of 88 patients with duodenal adenocarcinoma:23-79 years old,with an average age of 54.83 years old,male to female ratio:1.44∶1.Survival analysis showed that the median survival time of patients with and without metastasis of duodenal adenocarcinoma was 14 months and 19 months respectively,the prognosis of patients with metastasis was worse than those without metastasis(P<0.05).Univariate analysis showed that the presence or absence of metastasis,primary tumor diameter,clinical stage,chemotherapy regimens,types of chemotherapy drugs,surgical methods,Hp infection,CEA,CA199,AST/ALT,NKC,PLT,LMR were related to the prognosis of duodenal adenocarcinoma patients(P<0.05).Cox multivariate analysis suggested that metastasis,Hp(+),CA199>27 U/m L were the independent risk factors affecting the prognosis of patients with duodenal adenocarcinoma(P<0.05),and radical surgery was the duodenal Beneficial factors for the prognosis of patients with adenocarcinoma(P<0.05).Conclusion The prognosis of duodenal adenocarcinoma with metastasis is extremely poor,and early close monitoring is needed.Clinically,the prognosis of patients can be predicted by four indicators of metastasis,surgical method,Hp infection,and CA199.