十二指肠癌根治术后患者辅助化疗的临床疗效及预后因素分析

Analysis of effect and prognostic factors of adjuvant chemotherapy in patients after radical surgery for duodenal cancer

目的:观察辅助化疗对十二指肠癌根治术后患者预后的影响。方法:收集2008年9月至2019年12月经病理组织学确诊的51例十二指肠癌根治术后患者的临床资料。应用Kaplan-Meier法绘制生存曲线,寿命表法计算1年生存率和3年生存率,生存有差异行Log-rank检验,多因素分析采用Cox风险比例回归模型。结果:单因素分析显示,T分期、淋巴结转移、分化程度、神经侵犯及辅助化疗均与十二指肠癌根治术后患者的预后相关(P<0.05),性别、年龄、原发灶大小、术前是否有黄疸及胰腺侵犯均与预后无关(P>0.05)。多因素分析显示,术后辅助化疗(HR=0.08,95%CI:0.022~0.291,P<0.001)和淋巴结转移(HR=2.768,95%CI:1.223~6.268,P=0.015)是影响十二指肠癌根治术后患者的独立预后因素。亚组分析显示,T 1/T 2分期、无淋巴结转移及中高分化患者中,辅助化疗者的预后均优于未化疗者(P<0.001);GEMOX方案和FOLFOX方案无明显生存差异(P>0.05)。结论:辅助化疗是十二指肠癌根治术后患者的独立预后因素,无高危因素者也可从中获益,FOLFOX方案和GEMOX方案无明显生存差异,二者均可作为选择,但GEMOX方案可能具备潜在的生存优势。

Objective:To observe the effect of adjuvant chemotherapy on the prognosis of patients after radical surgery for duodenal cancer.Methods:The clinical data of 51 patients after radical surgery for duodenal cancer diagnosed by histopathology from September 2008 to December 2019 were collected.The Kaplan-Meier method was applied to draw the survival curve.The life table method was used to calculate the 1-year survival rate and the 3-year survival rate.The Log-rank test was performed for differences in survival,and the Cox proportional regression model was used for multivariate analysis.Results:Univariate analysis showed that T stage,lymph node metastasis,degree of differentiation,nerve invasion and adjuvant chemotherapy were all associated with the prognosis of patients after radical surgery for duodenal cancer(P<0.05),and gender,age,size of tumor,jaundice and pancreatic invasion before surgery were not associated with the prognosis(P>0.05).Multivariate analysis showed that adjuvant chemotherapy(HR=0.08,95%CI:0.022~0.291,P<0.001)and lymph node metastasis(HR=2.768,95%CI:1.223~6.268,P=0.015)were the independent prognostic factors affecting the patients after radical duodenal cancer.Subgroup analysis showed that the prognosis of those with adjuvant chemotherapy was better than that of those without chemotherapy in patients with T 1/T 2 stage,no lymph node metastasis and moderately/well differentiated patients(P<0.001).There was no significant difference in survival between the GEMOX regimen and the FOLFOX regimen(P>0.05).Conclusion:Adjuvant chemotherapy is an independent prognostic factor for patients after radical surgery for duodenal cancer,and those without high-risk factors may also benefit from it.There is no significant survival difference between the FOLFOX regimen and the GEMOX regimen,and both may be an option,but the GEMOX regimen may have a potential survival advantage.