影响胰腺癌切除术后生存时间的因素

综述影响胰腺癌切除术后生存时间的相关因素。性别、年龄对术后生存时间没有影响，肿瘤TNM分期、组织学类型、切缘阳性还是阴性与术后生存率关系密切。各种标准胰十二指肠切除术式的预后没有差别，对淋巴结阳性患者，扩大切除术的效果优于标准切除术，门静脉切除与否对术后生存时间无影响，但门静脉被癌组织侵犯者预后差。围手术期辅助治疗可以延长术后生存时间。肿瘤组织的某些分子生物学特征也与预后关系密切。     

应用Cox模型分析影响进行期胃癌患者切除术后生存因素

前瞻性随访调查１９８０－１９８９年１２年间５３９进行期胃癌切主后患者，随访率为９５．３６％。应用Ｃｏｘ比例风险模型，对影响其术后生存的可能因素进行多因素分析，并确立了术后生存预测模型。结果表明，影响进行期胃癌患者切除后生存的主要因素为：淋巴结转移率，淋巴结转移站，手术方式，肝转移，肿瘤大小，年龄，发生部位，其中以淋巴结转移率为最重要因素。     

影响食管贲门癌切除术后长期生存因素临床分析

我科自1977年6月～1982年6月经手术切除随访的食管癌327例,贲门癌194例,其5、7、9年生存率分别为:20.64％、23.08％、23.29％和15.92％、11.03％、13.33％,并对影响食管、贲门癌切除术后长期生存有关因素进行了分析,其中以癌灶长度,侵犯范围,手术类型,病理临床分期等为主要因素。强调了早期发现、早期诊断、早期治疗及提高手术操作技巧,切除足够的病变长度,积极清扫区域淋巴结,以使食管贲门癌尽可能达到根治性切除,对提高食管贲门癌的远期效果,具有重要意义。     

胰腺癌根治切除术后远期疗效的多因素分析

目的 探讨胰腺癌根治切除术后远期疗效的影响因素.方法 同顾性分析184例行根治切除术治疗的胰腺癌患者的临床病理资料,用Cox比例风险模型进行生存率多因素分析.结果 184例患者总的1、3和5年牛存率分别为61.7%、29.0%和14.3%.肿瘤直径＜3 cm者的1、3和5年生存率分别为78.0%、38.4%和25.7%,明显高于肿瘤直径≥3 cm者(52.8%、22.7%和7.2%,P＜0.05);无淋巴结转移者的1、3和5年生存率分别为67.6%、30.5%和17.4%,明显高于有淋巴结转移者(37.1%、20.6%和0,P＜0.05);I期患者的1、3和5年生存率分别为75.2%、47.4%和23.7%,II期患者的1、3和5年牛存率分别为68.2%、36.3%和21.8%,均明显高于Ⅲ期和Ⅳ期患者(均P＜0.05).Cox模型分析显示,肿瘤大小和有无淋巴结转移是影响胰腺癌根治术后患者远期疗效的独立因素(P＜0.05和P＜0.01).结论 提高胰腺痛患者远期疗效的关键是早期诊断以及对患者进行根治性切除治疗.     

胰腺癌:治疗性切除术

Resecting pancreatic cancer is the only chance for cure for this devastating disease . It increases survival significantly and may also contribute to a better quality of life . While median survival for patients with unresectable pancreatic cancer is only about 4-8 months, resective surgery improves prognosis to a median survival of 14-20 months and 5-year survival rates of up to 25% . A few studies compared curative resection versus incomplete （R1 and R2） resections whereas only one randomized trial was conducted comparing surgery versus chemoradiation . All these studies confirmed the survival benefit seen in the retrospective data analyses：     

胰腺癌:腹腔镜切除术

Objective： To assess current role of laparoscopic resection for pancreatic cancer, so as to improve the surgical management of pancreatic cancer. Methods： A comprehensive review of articles from PubMed was carried out. Results： Currently, the advantages of a complete laparoscopic pancreatoduodenectomy （LPD） are still outweighed by the morbidity associated with the procedure. However, laparoscopic distal pancreatectomy （LDP） offers patients benefits in terms of postoperative recovery and the length of hospital stay with similar morbidity and mortality to open surgery. Hand-assisted laparoscopic surgery can help to overcome the limitation of a complete laparoscopic surgery while maintaining a minimally invasive approach. Conclusion： Current literature suggests that laparoscopic resection of pancreatic cancer is feasible and safe in experienced hands. The hand-assisted laparoscopic surgery shows a promising future in pancreatic cancer surgery.     

胰腺癌胰十二指肠切除术后影响生存的因素

本文报告了89例胰头癌行胰十二指肠切除术的患者,术后住院死亡8例,死亡率为9%。作者分析了其余81例出院的患者,以期能找到影响长期生存的因素。81例患者中,男41例,女40例,平均年龄62岁。白人65例,黑人16例。平均手术时间7.5小时,估计平均失血量1000 ml。44例行传统的胰十二指肠切除术(包括1例胃窦切除术);37例行保留幽门的胰十二指肠切除术。69例行部分胰腺切除术;12例行全胰腺切除术。从切除的标本测定,29例肿瘤直径≤2 cm,52例>     

贲门癌切除术后生存10年以上病例分析

目的 探讨影响贲门癌切除术后长期生存的因素。方法 对５８４例贲门癌切除术后生存１０年病例进行回顾性分析。结果 本组１０年生存率为１７．１％。肿瘤的病理分期、分化程度、大体类型、瘤体大小对１０年生存率的影响均有显著性,有无淋巴结转移对１０年生存率的影响有非常显著性。伴有切端癌残留、癌栓形成、肿瘤浸润浆膜、手术切除性质、以及性别、年龄、病程等对１０年生存率影响无显著性,结论 贲门癌的早期发现、早期诊断     

扩大淋巴结清扫的胰十二指肠切除术治疗胰腺癌的临床意义

摘 要：［目的］ 探讨扩大淋巴结清扫的胰十二指肠切除术（PD）对于胰腺癌治疗的临床意义。［方法］ 回顾性分析195例行胰十二指肠切除术胰腺癌患者的临床及病理资料。根据手术方式不同将患者分为对照组：标准化淋巴结清扫的胰十二指肠切除术（110例）和实验组：扩大淋巴结清扫的胰十二指肠切除术（85例）。比较两组胰腺癌患者的手术情况、病理检查结果、术后并发症发生率、死亡率及术后生存时间等。［结果］ 实验组和对照组的平均手术时间分别为554min和443min,中位术中出血量分别为800ml和500ml,两组比较,差异均有统计学意义（P<0.05）。实验组和对照组患者的死亡率分别为3.53%和3.64%,两组比较差异无统计学差异（χ2= 0.483,P>0.05）。实验组和对照组术后并发症发生率分别为27.1%和24.5%,两组比较差异无统计学意义（χ2=3.804,P>0.05）。术后中位生存时间分别为18.6个月（95%CI：12.7~21.5）和16.9个月（95%CI：10.6~23.2）,两组比较差异无统计学意义（χ2=0.143,P>0.05）。［结论］ 扩大淋巴结清扫的胰十二指肠切除术虽然增加了手术时间及出血量,但并不增加术后并发症的发生率和死亡率。虽然对患者预后影响差异无统计学意义,但扩大淋巴结清扫的PD术总体生存时间仍比标准淋巴结清扫PD术延长1.7个月。     

子宫颈癌患者术后生存情况及其影响因素

 目的　探讨影响子宫颈癌患者术后生存的影响因素。方法　对1976年3月至1999年6月手术治疗的365例子宫颈癌患者临床资料和随访结果进行回顾性分析。采用Kaplan-Meier法计算累积生存率,用Log-Rank法比较各因素不同水平生存分布的差异。在单因素分析的基础上,进一步应用COX回归模型进行预后因素分析。结果　全组子宫颈癌术后患者5、10、15、20年累积生存率分别为88 %、83 %、81 %、80 %。Log-Rank分析结果显示,不同年龄、分期水平间生存差异有统计学意义（χ2＝19.738,P＜0.01;χ2＝36.672,P＜0.01）。随年龄和分期的升高,患者生存率均降低。术式、放疗不同水平间生存差异无统计学意义（均P＞0.05）。COX模型多因素分析表明,年龄、分期是影响预后的独立因素（均P＜0.01）。结论　年龄、分期是影响子宫颈癌预后的因素,早期治疗对子宫颈癌患者预后有重要意义,应提高早期发现率和早诊率。     

Prognostic factors for the survival of surgically treated patients for non-small cell lung cancer

The survival and outcome rates of 284 patients who underwent surgical treatment for non-small cell lung cancer were assessed retrospectively. Resectability rate was 94.1%, hospital mortality 3.9% (n=11) and the mortality rates in patients who underwent pneumonectomy or lobectomy were 8.9% and 0.6%, respectively. The overall 5-year survival was 43.6%. Female gender, earlier stages of disease and a complete resection were strongly predictive for a long-term survival. Women in stage IA disease had a 5-year survival rate of 92.7%. The 5-year survival rate for patients in stages IIIA and N2 disease who underwent a complete resection was 21.9%, and 9% for those who did not undergo a complete resection. It is concluded that the best surgical results were observed in women who were operated on at an early stage of disease. A complete resection also contributed to a better outcome, even for patients in stage IIIA and N2 disease.     

胆囊癌术后感染性并发症的危险因素分析

目的探讨胆囊癌术后感染性并发症的危险因素。方法回顾性分析本院2000年1月～2005年6月手术治疗的58例胆囊癌患者。分析22个有关病人、肿瘤及手术操作相关的独立因素，因变量为术后感染性并发症。Binary Logistic回归用于分析与因变量相关的独立的危险因素。结果总体术后并发症为32．8％（19／58），58例中14例（24．1％）出现了感染性并发症。单因素分析提示黄疸、低蛋白血症和术中输血与感染性并发症显著相关。多因素Logistic回归分析发现黄疸和术中4单位以上输血对术后感染性并发症具一定影响，但无显著性（OR值和95％c1分别为8．004、7．782和0．886-72．278、0．914～66．283），而体重减轻和低蛋白血症则与术后感染性并发症显著相关（OR值和95％CI分别为9．609、40．257和1．269-72．253、3．901-415．438）。结论体重减轻和低蛋白血症是影响胆囊癌术后感染性并发症的主要独立因素。     

Prognostic factors for survival of patients with advanced gastric cancer treated with cisplatin-based chemotherapy

Purpose The present study evaluated baseline patient- or tumor-related prognostic factors in patients with advanced gastric adenocarcinoma. Patients and methods A total of 304 consecutive patients with newly diagnosed metastatic or recurrent gastric cancer treated with one or more cycles of cisplatin-based chemotherapy at the Korea Cancer Center Hospital were enrolled in the current study. Results Among the original 304 patients, only 4 patients were alive at the time of this analysis. The median survival for all patients was 7.3 (95% CI, 6.3–8.2) months. Five independent prognostic factors were identified by a multivariate analysis: poor performance status (hazard ratio [HR], 1.46; 95% CI, 1.32–2.92), elevated total bilirubin (HR, 2.04; 95% CI, 1.73–2.35), presence of peritoneal metastasis (HR, 1.73; 95% CI, 1.57–1.90), presence of bone metastasis (HR, 3.11; 95% CI, 2.69–3.53), and more than 1 metastatic site (HR, 1.22; 95% CI, 1.06–1.38). A prognostic index was constructed that divided the patients into a good (n = 162), moderate (n = 82), or poor (n = 60) risk group. The 1-year survival rates for the good, moderate, and poor risk groups were 34.6, 20.7, and 1.7%, respectively, and the survival differences among the groups were highly significant (P < 0.0001). Conclusion Five prognostic factors were identified from patients receiving first-line cisplatin-based chemotherapy for advanced gastric cancer. A simple prognostic index was then developed that produced distinct survival rates among the different risk groups. Therefore, this prognostic model could help clinicians and patients in clinical decision-making and treatment tailoring based on the estimated prognosis.     

Family environment, hobbies and habits as psychosocial predictors of survival for surgically treated patients with breast cancer

Many psychosocial factors have been reported to influence the duration of survival of breast cancer patients. We have studied how family members, hobbies and habits of the patients may alter their psychosocial status. Female patients with surgically treated breast cancer diagnosed between 1986 and 1995 at the Tochigi Cancer Center Hospital, who provided information on the above-mentioned factors, were used. Their subsequent physical status was followed up in the outpatients clinic. The Cox regression model was used to evaluate the relationship between the results of the factors examined and the duration of the patients' survival, adjusting for the patients' age, stage of disease at diagnosis and curability, as judged by the physician in charge after the treatment. The following factors were revealed to be significant with regard to the survival of surgically treated breast cancer patients: being a widow (hazard ratio 3.29; 95% confidence interval 1.32-8.20), having a hobby (hazard ratio 0.43; 95% confidence interval 0.23-0.82), number of hobbies (hazard ratio 0.64; 95% confidence interval 0.41-1.00), number of female children (hazard ratio 0.64; 95% confidence interval 0.42-0.98), smoker (hazard ratio 2.08; 95% confidence interval 1.02-4.26) and alcohol consumption (hazard ratio 0.10; 95% confidence interval 0.01-0.72). These results suggest that psychosocial factors, including the family environment, where patients receive emotional support from their spouse and children, hobbies and the patients' habits, may influence the duration of survival in surgically treated breast cancer patients.      

Recurrence and survival in surgically treated endometrioid endometrial cancer

Introduction The objective of this study was to evaluate different surgical treatments and radiotherapy on patterns of recurrence and overall survival in patients with endometrioid-type endometrial cancer. Materials and methods The retrospective records of 162 patients with endometrioid endometrial cancer were collected. Patients were surgically treated from 1997 to 2002. Recurrence and survival were analyzed according to patient age, surgical procedure, lymphadenectomy, externalbeam irradiation, brachytherapy, surgical stage, myometrial invasion, and tumor grade. Standard statistical calculations were used. Results Median age was 64 years. Median follow-up was 44 months. Overall, ten patients (5.6%) experienced recurrence and 14 (8.6%) died. With univariate analysis, statistical significance for survival was found for age older than 70 years, tumor grade, myometrial invasion, and stage. Multivariate analysis, however, found only age, stage, and grade to be significant. With univariate analysis, statistical significance for recurrence was found for tumor grade, stage, and external-beam radiotherapy as risk factors. Multivariate analysis found only radiotherapy and brachytherapy to be significant, but in an inverted sense, with brachytherapy having a protective effect. Conclusion Our results suggest that brachytherapy protects against recurrence and that neither a surgical approach nor a lymphadenectomy appear to affect recurrence or survival in patients with surgically treated endometrioid endometrial cancer.     

Recurrence-free survival time for surgically treated soft tissue sarcoma patients. Multivariate analysis of five prognostic factors

A staging system, based upon the experience of 1215 patients, was published by the American Joint Committee Task Force on Soft Tissue Sarcoma in 1977. A subset of these patients, 594, was selected to study recurrence-free survival time. The authors found 331 patients with a recurrence within 5 years (100 local only, 123 metastatic only, and 108 local + metastatic); median months to recurrence was 9.7. Within 5 years, recurrence was clearly associated with mortality: among the 331 patients who experienced a recurrence, 245 died, whereas only 31 died among the 263 who had no recurrence. To further evaluate the utility of the published staging system, a multivariate analysis of five factors was carried out for 297 of the 594 patients (patients with unknown information for any one of these factors were excluded). Factors in addition to grade that exerted a significant influence on recurrence were: direct extension, symptoms, and location of tumor when survival was measured to the first of any recurrence, and tumor size, measuring survival to the first metastatic recurrence. It is therefore recommended that these factors be taken into account in staging this disease. Estimates of probable recurrence-free survival time based upon the multivariate model (Weibull) are also presented.     

Prognostic factors for survival in patients with advanced oesophageal cancer treated with cisplatin-based combination chemotherapy

The objective of this study was to identify prognostic factors for survival in patients with advanced oesophageal cancer, who are treated with cisplatin-based combination chemotherapy. We analysed the baseline characteristics of 350 patients who were treated in six consecutive prospective trials with one of the following regimens: cisplatin/etoposide, cisplatin/etoposide/5-fluorouracil, cisplatin/paclitaxel (weekly) and cisplatin/paclitaxel (biweekly). Predictive factors in univariate analyses were further evaluated using multivariate analysis (Cox regression). The median survival of all patients was 9 months. The 1, 2 and 5-year survival rates were 33, 12 and 4%, respectively. The main prognostic factors were found to be WHO performance status (0 or 1 vs 2), lactate dehydrogenase (normal vs elevated), extent of disease (limited disease defined as locoregional irresectable disease or lymph node metastases confined to either the supraclavicular or celiac region vs extensively disseminated disease) in addition to the type of treatment (weekly or biweekly cisplatin/paclitaxel regimen vs 4-weekly cisplatin/etoposide with or without 5-fluorouracil). Although weight loss, liver metastases and alkaline phosphatase were significant prognostic factors in univariate analyses, these factors lost their significance in multivariate analyses. The median survival for patients without any risk factors was 12 months, compared to only 4 months in patients with WHO 2 plus elevated LDH and extensive disease. The performance status, extent of disease, LDH and the addition of paclitaxel to cisplatin are independent prognostic factors in patients with advanced oesophageal cancer, who are treated with cisplatin-based combination chemotherapy.