胰腺导管腺癌根治性切除术后复发转移及预后影响因素分析

目的 探讨胰腺导管腺癌根治性切除术后复发转移及预后的影响因素.方法 回顾性分析56例胰腺导管腺癌根治性切除术患者的临床病理及随访资料,对患者术后复发转移及预后的影响因素进行单因素和多因素分析.结果 56例胰腺导管腺癌患者根治性切除术后复发转移率为73.2%(41/56),术后3个月、6个月、1年和2年复发转移率分别为26.8%(15/56)、51.8%(29/56)、64.3%(36/56)和69.6%(39/56).局部复发13例,肝转移15例,多脏器转移10例.病程、腰背痛症状、术前CA19-9水平、肿瘤大小、T分期、AJCC分期与胰腺导管腺癌术后复发转移有关(P＜0.05).患者3年累积生存率为22.7%.单因素分析结果显示,T分期、CA19-9水平和肿瘤大小与胰腺导管腺癌患者的预后有关(P＜0.05).多因素Cox回归分析结果显示,肿瘤大小是胰腺癌患者预后的独立影响因素(OR=2.08,95%C/为1.28～4.03).结论 胰腺导管腺癌多在术后2年内发生复发转移,肝脏是最常见的转移部位.病程、腰背痛、CA19-9、肿瘤大小、AJCC分期和T分期与术后复发转移有关,肿瘤大小是患者预后的独立影响因素.

Analysis of factors influencing recurrence and metastasis following curative resection of pancreatic ductal adenocarcinoma

Objective To investigate the factors influencing recurrence and metastasis following curative resection of pancreatic ducta]adenocareinoma and analyze the prognosis. Methods The clinicopathological and follow-up data of 56 patients who underwent curative resection for pancreatic ductal adenocarcinoma between Jan. 1997 and Dec. 2006 in this hospital were analyzed retrospectively. Results The recurrence rate after curative resection was 73.2% (41/56). The recurrence rate after operation at the time of 3 months, half yeax, 1 year and 2 years was 26.8% (15/56), 51.8% (29/56), 64.3% (36/56) and 69.6% (39/56), respectively. Hepatic metastasis and local recurrence accounted for 36.6% and 31.7% of the cases, respectively. The 3-year accumulated survival of this group was 22. 7%. The symptom presenting time, back pain, preoprative level of CA19-9, tumor size, AJCC stage and T stage were correlated with metastasis/recurrence. Univariate analysis revealed that the preoprative level of CA19-9, T stage and the tumor size were prognostic factors. Cox regression analysis revealed that only tumor size was an independent prognostic factor. Conclusion The metastasis or recurrence mostly occurs within 2 years after curative resection, and the liver is the most common site of metastasis. High recurrence rate is the major reason causing the failure of curative resection and short survival time after operation. The symptom presenting time, back pain, preoperative level of CA19-9, tumor size, AJCC stage and T stage are correlated with metastasis/recurrence. The tumor size is an independent prognostic factor.