胰腺癌2340例临床病例分析

目的 探讨提高胰腺癌治愈性切除的相关因素和获得更佳疗效的方法。方法 中国抗癌协会胰腺癌专业委员会回顾性分析8省2市14家三级甲等医院1990年至2000年来诊治的2340例胰腺病例。多因素生存分析采用Cox比例风险模型找出可能影响胰腺癌患者预后的独立因素。单因素生存分析用寿命表法计算,以生存曲线描述生存率,并进行Gehan比分检验。结果Cox单因素分析表明在α=0．05水平上有意义的有年龄、职业、病程、肿瘤部位、手术方式、术后胰瘘、术后肝衰、化疗、TNM分期、免疫治疗、有无肝转移、肠系膜上血管有无侵犯等变量。Cox多因素分析表明在α=0．05水平上有意义的有患者年龄、手术方式、术后胰瘘、术后肝衰、化疗、免疫治疗等变量,这些变量为影响胰腺癌预后的独立因素。根治性手术者相对于未手术者,以及化疗、免疫治疗均为保护性因素。其中40岁以上的占92．9％,40岁以下的仅占7．1％。胰头癌根治性手术组中位生存时间为17．1个月,1年、3年和5年生存率分别为54．4％,13．5％,8．5％。结论有必要将40岁以上的人群视为高危人群,以便及时发现早期病例。各种综合治疗措施的结合都将有助于改善胰腺癌患者的生活质量和延长生存期。

Clinical analysis of 2340 cases of pancreatic cancer

OBJECTIVE: To investigate the factors related to curable resection of pancreatic cancer and to obtain better efficacy. METHODS: A uniform questionnaire survey on the clinical epidemiology of pancreatic cancer was conducted by the Society of Pancreatic Cancer, Chinese Anti-cancer Association from January 1, 1990 to December 31, 2000 on a total of 2340 the patients with pancreatic cancer confirmed clinically or pathologically in 14 hospitals in China. Survival analysis was conducted for selected patients with complete data. Cox regression was used to screen out single and multiple risk factors. Cumulative survival rate was calculated by life table and Gehan score test. RESULTS: Cox single factor analysis showed that the significant variables at alpha = 0.05 level included age, occupation, duration of disease, location of neoplasm, operation type, postoperative pancreatic fistula, postoperative hepatic failure, chemotherapy, TNM stage, immunotherapy, liver metastasis, and invasion of the superior mesenteric vessel. Cox multifactor analysis revealed that the significant variables at alpha = 0.05 level included age, surgical procedures, postoperative pancreatic fistula, postoperative hepatic failure, chemotherapy, and immunotherapy. These were independent factors for the prognosis of patients with pancreatic carcinoma. Among these factors, age less than 70 years, radical operation, chemotherapy and immunotherapy were all protective factors. 92.9% of the patients were aged more than 40 years, and only 7.09% were less than 40 years. The median survival time of patients after radical resection of carcinoma of the pancreatic head was 17.11 months and the 1-year survival rate was 54.36%. The 3 and 5-year survival rates were 13.47% and 8.47%. CONCLUSION: For early diagnosis, an effective way to screen population older than 40 years is really an effective way to detect patients early and promptly. And comprehensive therapy is conducive to better quality of life and longer survival time.