胰头癌根治性胰十二指肠切除术后肿瘤早期复发的影响因素分析

目的探讨胰头癌根治性胰十二指肠切除术后肿瘤早期复发的影响因素。方法采用回顾性病例对照研究方法。收集2014年5月至2015年5月复旦大学附属肿瘤医院收治104例胰头癌行根治性切除术病人的临床病理资料;男62例,女42例;年龄为(61±10)岁。病人均行根治性胰十二指肠切除术。观察指标:(1)手术情况。(2)随访情况。(3)影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的因素。采用电话方式进行随访,了解病人复发情况。随访时间截至术后1年。正态分布的计量资料以x±s表示。计数资料以绝对数表示,组间比较采用χ²检验。多因素分析采用Logistic回归模型。结果(1)手术情况:104例病人均顺利完成根治性胰十二指肠切除术,术中出血量为(474±280)mL,淋巴结清扫数目为(21±10)枚。(2)随访情况:104例病人术后均获得随访,其中44例肿瘤早期复发。44例肿瘤早期复发病人中,腹腔内复发42例(肝转移23例、术区转移7例、后腹膜淋巴结转移7例、网膜转移5例);腹腔外复发2例(胸膜、肺转移各1例)。(3)影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的因素:单因素分析结果显示术前CA19-9水平、术后CA19-9水平、淋巴结转移数目是影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的相关因素(χ²=5.833,9.276,4.261,P<0.05)。多因素分析结果显示:术后CA19-9水平>37 U/mL是影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的独立危险因素(优势比=3.599,95%可信区间为1.551~8.347,P<0.05)。结论术后CA19-9水平>37 U/mL是影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的独立危险因素。

Influencing factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer

Objective To investigate the influencing factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 104 patients with pancreatic head cancer who underwent radical resection in Fudan University Shanghai Cancer Center from May 2014 to May 2015 were collected.There were 62 males and 42 females,aged(61±10)years.Patients underwent carative pancreaticoduodenectomy.Observation indicators:(1)surgical situations;(2)follow-up;(3)influencing factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer.Follow-up was conducted using telephone interview to detect recurrence of patients up to postoperative 1 year.Measurement data with normal distribution were represented as Mean±SD.Count data were described as absolutes numbers,and comparison between groups was analyzed using the chi-square test.Multivariate analysis was analyzed using the Logistic regression model.Results(1)Surgical situations:104 patients underwent curative pancreaticoduodenec-tomy successfully.The volume of intraoperative blood loss was(474±280)mL and the number of lymph node dissection was 21±10.(2)Follow-up:104 patients received postoperative follow-up,44 of whom had early recurrence.Of the 44 patients with early recurrence,42 cases had intraperitoneal recurrence including 23 cases with liver metastasis,7 cases with metastasis in surgical site,7 cases with retroperitoneal lymph node metastasis,5 cases with omentum metastasis,2 cases had extraperitoneal recurrence including 1 case with pleural metastasis and 1 case with pulmonary metastasis.(3)Influencing factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer:results of univariate analysis showed levels of preoperative CA19-9,levels of postoperative CA19-9,the number of lymph node dissection were related factors for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer(χ²=5.833,9.276,4.261,P<0.05).Results of multivariate analysis showed that postoperative CA19-9>37 U/mL was an independent risk factor for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer(odd ratio=3.599,95%confidence interval as 1.551-8.347,P<0.05).Conclusion Postoperative CA19-9>37 U/mL is an independent risk factor for early recurrence after curative pancreaticoduodenectomy of pancreatic head cancer.