Ahmad N A, Lewis J D, Ginsberg G G, Haller D G, Morris J B, Williams N N, Rosato E F, Kochman M L
Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania, USA.
Am J Gastroenterol. 2001 Sep;96(9):2609-15. doi: 10.1111/j.1572-0241.2001.04123.x.
The aim of this study was to determine the long term survival of patients with pancreatic adenocarcinoma who underwent surgical resection and to assess the association of clinical, pathological, and treatment features with survival.
Between January, 1990, and December, 1998, 125 patients underwent a pancreaticoduodenal or partial pancreatic resection for pancreatic ductal adenocarcinoma at our institution. The records of these patients were reviewed for demographics, tumor characteristics including size, histological grade, margin status, lymph node status, surgical TNM staging, and postoperative adjuvant therapy. The primary outcome variable analyzed was survival.
A total of 116 patients had complete follow-up and were included in the final analysis. The median survival after surgery was 16 months. The 1-, 3-, 5-, and 7-yr survival rates for all 116 patients were 60%, 23%, 19%, and 11%, respectively. The 1-, 3-, 5-, and 7-yr survival rates for patients who received adjuvant therapy were 69%, 28%, 23%, and 18% compared with 20% and 0% in patients who did not receive adjuvant therapy (p < 0.0001). The 1-, 3-, 5-, and 7-yr survival rates for patients with negative lymph nodes were 73%, 38%, 26%, and 22% compared with survival rates of 52%, 14%, 14%, and 9% in patients with positive lymph nodes (p = 0.01). In multivariate analyses, adjuvant therapy was the only feature found to be strongly associated with survival (hazards ratio = 0.26, 95% CI = 0.15-0.44).
The overall 5- and 7-yr survival rates of 19% and 11% in our study further validate that surgical resection in patients with pancreatic adenocarcinoma can result in long term survival, particularly when performed in association with adjuvant chemoradiation.
本研究旨在确定接受手术切除的胰腺腺癌患者的长期生存率，并评估临床、病理和治疗特征与生存率的相关性。
1990年1月至1998年12月期间，我院125例患者因胰腺导管腺癌接受了胰十二指肠切除术或部分胰腺切除术。对这些患者的记录进行了回顾，内容包括人口统计学信息、肿瘤特征（包括大小、组织学分级、切缘状态、淋巴结状态、手术TNM分期）以及术后辅助治疗情况。分析的主要结局变量为生存率。
共有116例患者获得完整随访并纳入最终分析。术后中位生存期为16个月。116例患者的1年、3年、5年和7年生存率分别为60%、23%、19%和11%。接受辅助治疗患者的1年、3年、5年和7年生存率分别为69%、28%、23%和18%，而未接受辅助治疗患者的相应生存率分别为20%和0%（p<0.0001）。淋巴结阴性患者的1年、3年、5年和7年生存率分别为73%、38%、26%和22%，而淋巴结阳性患者的生存率分别为52%、14%、14%和9%（p=0.01）。多因素分析显示，辅助治疗是唯一与生存率密切相关的因素（风险比=0.26，95%可信区间=0.15-0.44）。
本研究中19%和11%的总体5年和7年生存率进一步证实，胰腺腺癌患者的手术切除可带来长期生存，尤其是联合辅助放化疗时。
