Ridwelski K, Meyer F, Ebert M, Malfertheiner P, Lippert H
Division of Oncosurgery/Oncology, Department of Surgery, University Hospital, Otto von Guericke University, Magdeburg, Germany.
Dig Dis. 2001;19(1):85-92. doi: 10.1159/000050657.
Prognosis and outcome of patients with pancreatic carcinoma is poor. The aim of the study was to investigate (1) which factors of medical history and clinical status as well as which laboratory parameters determine survival in pancreatic carcinoma and (2) whether specific data can be used as prognostic parameters or for early diagnosis of pancreatic carcinoma. In total, 287 patients with pancreatic carcinoma were enrolled in the study. In 193 subjects, only palliative treatment was possible. Survival was assessed using univariate survival probability curves by Kaplan-Meier. Comparison of patient groups with regard to survival was achieved using the log-rank test. Multivariate analysis was carried out using the Cox regression model. Overall, 22 factors, showing a significant impact on survival in pancreatic carcinoma were found, e.g., tumor-associated factors such as (1) tumor stage according to the UICC classification including TNM-based staging, grading, tumor site, and vascular infiltration; (2) preoperative habits and signs and symptoms (physical condition, pain, loss of appetite, ethanol consumption); (3) change of laboratory parameters (CA 19-9, bilirubin, prothrombin time, urea, C-reactive protein), and (4) type of intervention (surgical approach, R0/1/2 resection). Using multivariate analysis, seven factors (UICC tumor stage and site, surgical intervention including number of resected lymph nodes, chemotherapy, occurence of a carcinoma in relatives, preoperative physical condition, night sweat) were determined. In the 193 patients with palliative treatment, only ten factors (among them UICC tumor stage including the presence of metastases; data from the medical history such as physical condition, loss of appetite, and carcinoma in relatives, and laboratory parameters including prothrombin time, protein content, and aspartate aminotransferase levels) were found to be important. Chemotherapy had the strongest impact on survival which was confirmed by multivariate analysis, followed by tumor stage (UICC) and preoperative appetite. Besides tumor-associated determinants, data from the medical history, and pathological laboratory parameters, the prognosis in pancreatic carcinoma is considerably determined by the treatment such as interventional and/or using antineoplastic agents.
胰腺癌患者的预后和结局较差。本研究的目的是调查：（1）病史和临床状况的哪些因素以及哪些实验室参数决定胰腺癌患者的生存情况；（2）特定数据是否可作为预后参数或用于胰腺癌的早期诊断。共有287例胰腺癌患者纳入本研究。其中193例患者仅能接受姑息治疗。采用Kaplan-Meier单变量生存概率曲线评估生存情况。使用对数秩检验比较不同患者组的生存情况。采用Cox回归模型进行多变量分析。总体而言，发现22个因素对胰腺癌患者的生存有显著影响，例如肿瘤相关因素，如（1）根据国际抗癌联盟（UICC）分类的肿瘤分期，包括基于TNM的分期、分级、肿瘤部位和血管浸润；（2）术前习惯以及体征和症状（身体状况、疼痛、食欲减退、乙醇摄入）；（3）实验室参数变化（CA 19-9、胆红素、凝血酶原时间、尿素、C反应蛋白）；（4）干预类型（手术方式、R0/1/2切除）。通过多变量分析确定了7个因素（UICC肿瘤分期和部位、手术干预包括切除淋巴结数量、化疗、亲属中患癌情况、术前身体状况、盗汗）。在193例接受姑息治疗的患者中，仅发现10个因素（其中包括UICC肿瘤分期，包括有无转移；病史数据如身体状况、食欲减退和亲属中患癌情况；实验室参数包括凝血酶原时间、蛋白含量和天冬氨酸转氨酶水平）较为重要。多变量分析证实化疗对生存的影响最大，其次是肿瘤分期（UICC）和术前食欲。除了肿瘤相关决定因素、病史数据和病理实验室参数外，胰腺癌的预后在很大程度上还取决于治疗方式，如介入治疗和/或使用抗肿瘤药物。
