Takai S, Satoi S, Toyokawa H, Yanagimoto H, Sugimoto N, Tsuji K, Araki H, Matsui Y, Imamura A, Kwon A-H, Kamiyama Y
First Department of Surgery, Kansai Medical University, Moriguchi city, Osaka, Japan.
Pancreas. 2003 Apr;26(3):243-9. doi: 10.1097/00006676-200304000-00007.
Between April 1992 and December 2000, 167 patients with pancreatic carcinoma were evaluated and treated in our department. One hundred eight patients (64.7%) with pancreatic carcinoma underwent pancreatectomy. Of these patients, 94 had histologically proven ductal adenocarcinoma. The overall postoperative mortality rate was 3.2% (3 patients), and the morbidity rate was 35.1% (33 patients). The estimated 1-, 2-, 3-, and 5-year survival rates were 43.6%, 28.7%, 21.8%, and 12.9%, respectively. There were only six long-term survivors who survived >5 years after surgery. METHODOLOGY AND AIMS: Institutional experience with 94 consecutive patients with ductal adenocarcinoma who underwent pancreatectomy was reviewed to clarify the influence of 29 prognostic factors (5 host, 17 tumor, and 7 treatment factors). Special reference was made to determine whether these significant factors have an effect on long-term survival. Univariate and multivariate models were used to analyze the effect of prognostic factors on survival.
Univariate analysis indicated that blood loss, operative time, postoperative complications, histopathologic lymphatic and venous permeation, lymph node metastasis, conclusive stage, conclusive curability, resection margins, serosal invasion, size of tumor, retroperitoneal invasion, major arterial invasion, and mode of histologic infiltration were associated with significantly longer survival (p < 0.05). By Cox proportional hazards survival analysis, the most powerful predictors of outcome were venous permeation, lymph node metastasis, tumor diameter, and conclusive curability. The longest-term survivor had the most advanced stage (stage IV(b)) of disease and curability C. No long-term survivors had all of the good prognostic factors (according to multivariate analysis).
The prognosis after surgical resection of pancreatic carcinoma mostly depends on tumor factors. In this study, it was difficult to identify the determinants of long-term survival in patients with resectable tumors.
1992年4月至2000年12月期间，我科对167例胰腺癌患者进行了评估和治疗。108例（64.7%）胰腺癌患者接受了胰腺切除术。其中，94例经组织学证实为导管腺癌。术后总死亡率为3.2%（3例患者），发病率为35.1%（33例患者）。估计1年、2年、3年和5年生存率分别为43.6%、28.7%、21.8%和12.9%。术后存活超过5年的长期存活者仅有6例。
回顾了94例连续接受胰腺切除术的导管腺癌患者的机构经验，以阐明29个预后因素（5个宿主因素、17个肿瘤因素和7个治疗因素）的影响。特别参考确定这些显著因素是否对长期生存有影响。采用单因素和多因素模型分析预后因素对生存的影响。
单因素分析表明，失血量、手术时间、术后并发症、组织病理学淋巴管和静脉浸润、淋巴结转移、最终分期（conclusive stage）、最终可治愈性（conclusive curability）、手术切缘、浆膜侵犯、肿瘤大小、腹膜后侵犯、主要动脉侵犯和组织学浸润方式与显著更长的生存期相关（p < 0.05）。通过Cox比例风险生存分析，结果的最有力预测因素是静脉浸润、淋巴结转移、肿瘤直径和最终可治愈性。长期存活时间最长的患者疾病分期最晚期（IV(b)期）且可治愈性为C级。根据多因素分析，没有长期存活者具备所有良好的预后因素。
胰腺癌手术切除后的预后主要取决于肿瘤因素。在本研究中，难以确定可切除肿瘤患者长期生存的决定因素。
