胰体尾癌患者的预后影响因素分析

Analysis of prognostic factors in patients with pancreatic body and tail carcinoma

目的探讨影响胰体尾癌患者的预后因素。方法回顾性分析2013年1月至2020年3月间嘉兴学院附属第二医院行手术切除或内镜超声穿刺活检并经病理证实的64例胰体尾癌患者的临床资料。收集患者的年龄、性别、是否合并糖尿病、初诊时血清CEA及CA19-9水平、肿瘤部位、肿瘤最大直径、TNM分期、治疗方式等。采用Kaplan-Meier法绘制生存曲线,采用Log-rank检验进行生存率的分析。应用单因素和多因素Cox比例风险回归模型进行预后分析。结果64例患者中合并糖尿病者24例;血清CEA水平升高36例,CA19-9水平升高46例;TNMⅠA期8例、ⅠB期4例、ⅡA期4例、ⅡB期4例、Ⅲ期8例、Ⅳ期36例。采用对症治疗18例,化疗联合免疫治疗18例,综合治疗(手术联合化疗和免疫治疗)28例。单因素分析结果显示,糖尿病、血清CEA及CA19-9水平、TNM分期、治疗方式是影响胰体尾癌患者预后的因素(P值均<0.05)。多因素分析结果表明,TNM分期(HR=2.536)及综合治疗(HR=0.285)是影响胰体尾癌患者预后的独立因素(P<0.05)。经综合治疗的TNMⅢ+Ⅳ期胰体尾癌患者的中位生存期为25个月(95%CI 21.416~28.584),化疗联合免疫治疗的中位生存期为11个月(95%CI 7.246~14.754),对症治疗的中位生存期为6个月(95%CI 3.819~8.181),综合治疗患者中位生存期较化疗联合免疫治疗及对症治疗患者明显延长,差异有统计学意义(P<0.05)。结论TNM分期及综合治疗是影响胰体尾癌患者的预后因素,手术联合化疗和免疫治疗可能是患者获得长期生存的最佳选择。

Objective To investigate the prognostic factors of patients with pancreatic body and tail carcinoma.Methods The clinical data of 64 patients with pancreatic body and tail carcinoma who underwent surgical resection or endoscopic ultrasound biopsy and were pathologically confirmed in the Second Affiliated Hospital of Jiaxing University from January 2013 to March 2020 were retrospectively analyzed.Age,gender,diabetes mellitus,serum CEA and CA19-9 levels at initial diagnosis,tumor site,maximum tumor diameter,TNM stage and treatment method were collected.Kaplan-Meier method was used to draw survival curve,and Log-rank test was used to analyze survival rate.Univariate and multivariate Cox proportional risk regression models were used for prognostic analysis.Results Among the 64 patients,24 patients were complicated with diabetes;serum CEA level was increased in 36 cases,and serum CA19-9 level was increased in 46 cases;8 cases were in TNM stageⅠA,4 cases were inⅠB stage,4 cases wereⅡA stage,4 cases were inⅡB stage,8 cases were inⅢstage,and 36 cases were inⅣstage.Symptomatic treatment was performed in 18 cases,chemotherapy combined with immunotherapy were in 18 cases,and surgical comprehensive therapy(surgery combined with chemotherapy and immunotherapy)were in 26 cases.Univariate analysis showed that diabetes mellitus,serum CEA and CA19-9 levels,TNM stage and treatment mode were related factors affecting the prognosis of patients with pancreatic body and tail carcinoma(all P value<0.05).Multivariate analysis indicated that TNM stage(HR=2.536)and surgical comprehensive therapy(HR=0.285)were the independent factors affecting the prognosis of patients with pancreatic body and tail carcinoma(P<0.05).Median survival was 25 months(95%CI 21.416-28.584)for patients with TNM stageⅢ+Ⅳpancreatic body and tail carcinoma treated with surgical comprehensive therapy,11 months(95%CI 7.246-14.754)for patients treated with chemotherapy combined with immunotherapy,and 6 months(95%CI 3.819-8.181)for patients treated with symptomatic treatment;the median survival time of patients with surgical comprehensive therapy was significantly longer than that of patients with chemotherapy combined with immunotherapy and symptomatic treatment,and the difference was statistically significant(P<0.05).Conclusions TNM stage and surgical comprehensive therapy were the prognostic factors affecting the prognosis of patients with pancreatic body and tail carcinoma,and surgical comprehensive therapy may be the best choice for long-term survival of patients.