胰头癌：189例临床分析

Hua Yun-Peng, Liang Li-Jian, Peng Bao-Gang, Li Shao-Qiang, Huang Jie-Fu

Department of Hepatobiliary Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.

Hepatobiliary Pancreat Dis Int. 2009 Feb;8(1):79-84.

BACKGROUND

Pancreatic cancer is a lethal disease with an increasing incidence. We retrospectively reviewed the clinical data on diagnosis and treatment of pancreatic head carcinoma, and analyzed the factors affecting prognosis of the disease.

METHODS

The data of 189 patients with pancreatic head carcinoma treated from September 1, 1995 to August 31, 2005 were reviewed retrospectively. Ninety-four patients treated from September 1, 2000 to August 31, 2005 were followed up in April 2008. The median survival time (MST) and 1- to 5- year cumulative survival rates of the patients were calculated by the life table method and the Kaplan-Meier method. Cox regression was used to screen out significant risk factors.

RESULTS

96.9% of the patients were more than 40 years old, and the male/female ratio was 1.63. The detection rate of transabdominal ultrasonography (US), computed tomography (CT), endoscopic ultrasonography (EUS), and serum tumor marker CA19-9 were 82.0%, 93.1%, 94.7% and 79.8%, respectively. The MST of patients with pancreatic head carcinoma was 360+/-60 days. The 1- to 5-year cumulative survival rates were 50.0%, 19.2%, 12.1%, 9.4% and 4.7%, respectively. However, patients with unresectable tumor survived for a shorter time (183+/-18 days). Their 1- to 2-year cumulative survival rates were 28.3% and 0.0%. Cox regression analysis showed that in pancreatic head carcinoma, the independent predictors for prognosis included tumor size, invasion of the superior mesenteric vessel, and radical resection. The MST of patients with pancreatic head carcinoma after radical resection was 510 days, significantly longer than that of patients undergoing non-specific treatment and palliative therapy (225 days). In addition, patients with slight jaundice survived for the longest time (533+/-51 days), compared with patients with severe jaundice (236+/-43 days) and without jaundice (392+/-109 days).

CONCLUSIONS

Pancreatic head carcinoma is easily misdiagnosed, and is usually found to be advanced when tumor size is too large (above 4 cm in diameter) with local spread or metastatic disease. In these cases, surgical resection is usually not feasible, and its prognosis is usually very poor. Therefore, careful attention should be paid to these high-risk patients, especially, males, more than 40 years old, and presenting slight jaundice. Then imaging examination (US, CT and EUS) and serum tumor marker examination (CA19-9) are used to detect this disease earlier, and perform curative resection earlier. In this way, it is possible to cure the patients with a longer survival time and better quality of life.

背景

胰腺癌是一种发病率不断上升的致命疾病。我们回顾性分析了胰头癌的诊断和治疗临床资料，并分析了影响该疾病预后的因素。

方法

回顾性分析1995年9月1日至2005年8月31日期间治疗的189例胰头癌患者的数据。对2000年9月1日至2005年8月31日期间治疗的94例患者于2008年4月进行随访。采用寿命表法和Kaplan-Meier法计算患者的中位生存时间（MST）及1至5年累积生存率。采用Cox回归筛选出显著的危险因素。

结果

96.9%的患者年龄超过40岁，男女比例为1.63。经腹超声（US）、计算机断层扫描（CT）、内镜超声（EUS）及血清肿瘤标志物CA19-9的检出率分别为82.0%、93.1%、94.7%和79.8%。胰头癌患者的MST为360±60天。1至5年累积生存率分别为50.0%、19.2%、12.1%、9.4%和4.7%。然而，无法切除肿瘤的患者生存时间较短（183±18天）。其1至2年累积生存率分别为28.3%和0.0%。Cox回归分析显示，在胰头癌中，预后的独立预测因素包括肿瘤大小、肠系膜上血管侵犯及根治性切除。根治性切除术后胰头癌患者的MST为510天，明显长于接受非特异性治疗和姑息治疗的患者（225天）。此外，轻度黄疸患者生存时间最长（533±51天），而重度黄疸患者（236±43天）和无黄疸患者（392±109天）生存时间较短。

结论

胰头癌易被误诊，通常在肿瘤体积过大（直径超过4cm）伴有局部扩散或转移时才被发现处于晚期。在这些情况下，手术切除通常不可行，其预后通常很差。因此，应密切关注这些高危患者，尤其是40岁以上的男性且伴有轻度黄疸者。然后采用影像学检查（US、CT和EUS）及血清肿瘤标志物检查（CA19-9）尽早发现该疾病，并尽早进行根治性切除。这样才有可能治愈患者，延长生存时间并提高生活质量。