54例晚期十二指肠癌临床病理特征、化疗疗效及生存分析

Clinical characteristics and curative effect of chemotherapy of 54 cases with advanced duodenal carcinoma

目的探讨晚期十二指肠癌的临床病理特征、化疗疗效获益情况、优选化疗方案,观察预后情况。方法回顾本院2013年5月至2020年1月收治的经病理明确为晚期十二指肠癌患者的病历资料,分析其临床病理特征,采用RECIST 1.1实体瘤评价标准评价化疗疗效,统计不良反应,用Log-rank法进行生存分析,并绘制KaplanMeier生存曲线。结果54例晚期十二指肠癌患者中,病理类型以腺癌为主(53例),发病部位多为降部(42例)。55.56%的患者CA19-9升高,CEA升高患者占40.74%。与对照组比较,十二指肠癌组患者凝血指标中凝血酶原时间(PT)、纤维蛋白原(FIB)水平、D-二聚体水平、血小板(PLT)计数显著升高,而凝血酶时间(TT)、抗凝血酶Ⅲ(AT-Ⅲ)水平显著降低,差异均有统计学意义(P<0.05)。31例接受化疗患者与23例未化疗患者的中位总生存期(OS)分别为17.02个月和8.18个月,差异有统计学意义(P<0.05)。一线化疗采用奥沙利铂联合方案组与吉西他滨联合方案组疗效相似,奥沙利铂联合方案组OS较长,但组间差异无统计学意义(19.59个月vs.14.96个月,P=0.39)。结论晚期十二指肠癌患者化疗后生存时间明显优于未化疗患者,一线采用奥沙利铂联合方案或吉西他滨联合方案的疗效及生存时间相当,血液指标检测及病理活检对明确诊断及疗效分析具有指导意义,但仍需加大样本量进一步研究。本次临床实践的个体化、探索性治疗经验值得借鉴。

Objective To investigate the clinicopathological features,benefit of chemotherapy,optimal chemotherapy regimen and prognosis of advanced duodenal carcinoma.Methods The medical records of advanced duodenal cancer patients admitted to our hospital between May 2013 and Jan.2020 were reviewed,and their clinicopathological features were analyzed.The efficacy of chemotherapy was evaluated according to the response evaluation criteria in solid tumors(RECIST)version 1.1,and adverse reactions were recorded.Also,their survival data was analyzed by Log-rank method,and Kaplan-Meier survival curve was drawn.Results Among the 54 patients with advanced duodenal cancer,the pathological type was mainly adenocarcinoma(53 cases),and most of the tumors were located in the descending part(42 cases).CA19-9 and CEA were elevated in 55.56%and 40.74%of the patients,respectively.Compared with the control group,the prothrombin time(PT)and the levels of fibrinogen(FIB)and D-dimer and platelet(PLT)count were significantly increased in the duodenal carcinoma group,while the thrombin time(TT)and antithrombinⅢ(AT-Ⅲ)level were significantly decreased in the duodenal carcinoma group,and the differences were statistically significant(P<0.05).The median overall survival(OS)of 31 patients receiving chemotherapy and 23 patients without chemotherapy was 17.02 and 8.18 months,respectively(P<0.05).The efficacy of oxaliplatin combined regimen group in first-line chemotherapy was similar to that of gemcitabine combined regimen group.Though the OS in oxaliplatin combined regimen group was prolonged,there was no statistical difference(19.59 months vs.14.96 months,P=0.39).Conclusion The survival time of patients with advanced duodenal cancer after chemotherapy is significantly better than that of patients without chemotherapy.The first-line oxaliplatin or gemcitabine combined regimen has similar efficacy and survival time.The detection of blood indexes and pathological biopsy have guiding significance for definite diagnosis and efficacy analysis,but the sample size still needs to be increased for further study.And the experience of individualized and exploratory treatment in this clinical practice is worthy of reference.