Ueda Michio, Endo Itaru, Nakashima Masayuki, Minami Yuta, Takeda Kazuhisa, Matsuo Kenichi, Nagano Yasuhiko, Tanaka Kuniya, Ichikawa Yasushi, Togo Shinji, Kunisaki Chikara, Shimada Hiroshi
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
World J Surg. 2009 Jan;33(1):104-10. doi: 10.1007/s00268-008-9807-2.
The purpose of this study was to identify important prognostic factors related to the status of a pancreatic tumor, its treatment, and the patient's general condition.
Between April 1992 and December 2006, 140 patients underwent a pancreatic resection for invasive ductal carcinoma. Prognostic factors were defined by univariate and multivariate analyses.
The study included 103 tumors in the head of the pancreas and 37 tumors in the body or tail. The median survival time and the actuarial 5-year survival rate for all patients were 14.5 months and 12.3%, respectively. Using the significant prognostic factors identified by univariate analysis, multivariate analysis revealed that a preoperative serum CA19-9 concentration>100 U/ml (HR=1.84, p=0.0074), a tumor size>3 cm (HR=1.74, p=0.0235), venous involvement (HR=2.39, p=0.0006), a transfusion requirement of >or=1000 ml (HR=2.23, p=0.0006), and a serum albumin concentration on 1 postoperative month (1POM)<3 g/dl (HR=2.40, p=0.0009) were significant adverse prognostic factors. The presence of hypoalbuminemia on 1POM significantly correlated with a longer surgical procedure (p=0.0041), extended nerve plexus resection around the superior mesenteric artery (p=0.0456), and a longer postoperative hospital stay (p=0.0063).
To improve long-term survival, preserving the patient's general condition by performing a curative resection with a short operation time and minimal blood loss should be the most important principle in the surgical treatment of pancreatic cancer.
本研究旨在确定与胰腺肿瘤状态、其治疗及患者一般状况相关的重要预后因素。
1992年4月至2006年12月期间，140例患者因浸润性导管癌接受了胰腺切除术。通过单因素和多因素分析确定预后因素。
该研究包括103例胰头肿瘤和37例胰体或胰尾肿瘤。所有患者的中位生存时间和精算5年生存率分别为14.5个月和12.3%。使用单因素分析确定的显著预后因素，多因素分析显示术前血清CA19-9浓度>100 U/ml（HR=1.84，p=0.0074）、肿瘤大小>3 cm（HR=1.74，p=0.0235）、静脉受累（HR=2.39，p=0.0006）、输血需求量≥1000 ml（HR=2.23，p=0.0006）以及术后1个月（1POM）血清白蛋白浓度<3 g/dl（HR=2.40，p=0.0009）是显著的不良预后因素。1POM时低白蛋白血症的存在与手术时间延长（p=0.0041）、肠系膜上动脉周围广泛神经丛切除（p=0.0456）及术后住院时间延长（p=0.0063）显著相关。
为提高长期生存率，通过进行手术时间短、失血少的根治性切除来维持患者的一般状况应是胰腺癌外科治疗中最重要的原则。
