[通过组织学分级和病理N分期预测可根治性切除的胰腺腺癌患者的预后]
[Prediction of prognosis of patients with pancreatic adenocarcinoma with curative intent resection by means of histologic grade and pathologic N stage].
作者信息
Soriano-Izquierdo Antonio, Adet Ana C, Gallego Rosa, Miquel Rosa, Castells Antoni, Pellisé María, Nadal Cristina, López-Boado Miguel A, Piqué Josep M, Gascón Pere, Conill Carles, Bombí Antoni, Fernández-Cruz Laureano, Maurel Joan, Navarro Salvador
机构信息
Servicio de Gastroenterología, Institut de Malalties Digestives i Metabòliques, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERehd. Universidad de Barcelona, Barcelona, España.
出版信息
Med Clin (Barc). 2009 Feb 14;132(5):163-71. doi: 10.1016/j.medcli.2008.07.012. Epub 2009 Feb 7.
BACKGROUND AND OBJECTIVE
Pancreatic cancer has the poorest prognosis of any common gastrointestinal malignancy, with a 5-year overall survival of less than 5%. A better knowledge of prognostic factors related to this neoplasia might help improve the survival of these patients. We evaluated the prognostic significance of different factors in both overall survival and tumor recurrence in patients with pancreatic adenocarcinoma who had undergone pancreatic resection with curative intent.
PATIENTS AND METHOD
All patients with pancreatic adenocarcinoma submitted to surgical resection in our unit from January 1995 to February 2005 were evaluated. Twenty-three pre-surgical, therapeutic, and histopathologic variables were analyzed. Univariate (Kaplan-Meier, log-rank test) and multivariate (Cox regression) analyses were performed to select independent prognostic factors.
RESULTS
Ninety-four patients were evaluated. The median age of patients was 63 years and 53% were woman. The probability of overall survival was 63% at 1 year, 18% at 3 years, and 8% at 5 years, with a median survival of 18 months. Univariate analysis identified performance of adjuvant therapy, histologic grade, percentage of involved-resected lymph nodes, pathologic N stage, and pathologic TNM stage as variables associated with overall survival. On the other hand, the probability of tumor recurrence was 52% at 1 year, 83% at 3 years, and 91% at 5 years, with a median time to tumor recurrence of 12 months. Predictive variables of tumor recurrence in the univariate analysis were preoperative N stage, preoperative TNM stage, postoperative CA 19.9 serum concentration, histological grade, percentage of involved-resected lymph nodes, pathologic N stage and pathologic TNM stage. Multivariate analysis identified histological grade and pathologic N stage as independent predictive factors of both overall survival (histologic grade: HR=2.341 [CI 95%, 1.342-4.098; p=0.003]; pathologic N stage: HR=2.242 [1.213-4.149; p=0.01]) and tumor recurrence (histological grade: HR=1.742 [CI 95%, 1.121-3.086; p=0.05]; pathologic N stage: HR=2.096 [1.089-4.032; p=0.027]).
CONCLUSIONS
The histological grade and pathologic N stage predict the prognosis of patients with pancreatic adenocarcinoma after surgical resection.
背景与目的
胰腺癌是所有常见胃肠道恶性肿瘤中预后最差的，5年总生存率低于5%。更好地了解与这种肿瘤相关的预后因素可能有助于提高这些患者的生存率。我们评估了接受根治性胰腺切除术的胰腺腺癌患者中不同因素对总生存和肿瘤复发的预后意义。
患者与方法
对1995年1月至2005年2月在我院接受手术切除的所有胰腺腺癌患者进行评估。分析了23个术前、治疗和组织病理学变量。采用单因素分析（Kaplan-Meier法、对数秩检验）和多因素分析（Cox回归）来选择独立的预后因素。
结果
共评估了94例患者。患者的中位年龄为63岁，女性占53%。1年总生存率为63%，3年为18%，5年为8%，中位生存期为18个月。单因素分析确定辅助治疗的实施、组织学分级、切除淋巴结受累百分比、病理N分期和病理TNM分期为与总生存相关的变量。另一方面，肿瘤复发的概率1年时为52%，3年时为83%，5年时为91%，肿瘤复发的中位时间为12个月。单因素分析中肿瘤复发的预测变量为术前N分期、术前TNM分期、术后CA 19.9血清浓度, 组织学分级、切除淋巴结受累百分比、病理N分期和病理TNM分期。多因素分析确定组织学分级和病理N分期为总生存（组织学分级：HR=2.341 [95%CI，1.342 - 4.098；p=0.003]；病理N分期：HR=2.242 [1.213 - 4.149；p=0.01]）和肿瘤复发（组织学分级：HR=1.742 [95%CI，1.121 - 3.086；p=0.05]；病理N分期：HR=2.096 [1.089 - 4.032；p=0.027]）的独立预测因素。
结论
组织学分级和病理N分期可预测胰腺腺癌患者手术切除后的预后。
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