Wang Yi, Zhao Ping, Wang Cheng-feng, Shan Yi, Zhao Dong-bing, Tian Yan-tao, Sun Yue-min, Che Xu, Zhang Jian-wei
Department of Abdominal Surgery, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Beijing 100021, China.
Zhonghua Yi Xue Za Zhi. 2009 Sep 15;89(34):2381-5.
To analyze the value of combined therapy in pancreatic cancer with a poor prognosis.
The prognostic factors of pancreatic cancer with different clinicopathological characteristics and treatment modalities were analyzed retrospectively and the cumulative curve was plotted using the Kaplan-Meier method.
(1) From January 2001 to December 2005, 233 patients with pathological and cytological diagnosis of pancreatic cancer were analyzed. The median survival of all patients was 8.67 months, the 1-year survival rate 29.6% and the 5-year survival rate 4.5%. (2) Weightloss cases had a median survival of 7.7 months versus 10.0 months for cases without weightloss (P = 0.003). Back pain cases had a median survival of 6.5 months versus 9.0 months for cases without back pain (P = 0.015). Cases with normal CA19-9 levels (< or = 37 U/ml) had a median survival of 11.0 months versus 8.0 months for cases with CA19-9 > 37 U/ml levels (P = 0.000). Stages III and IV disease cases had a median survival of 8.7 and 6.3 months versus 16.0 months for cases of Stages I + II (P = 0.000). In the present study, patients suffering from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV were defined as cases with a poor prognosis. (3) Patients were grouped as pancreatectomy group, cancer-directed treatment group (including intraoperative iodine-125 seed interstitial brachytherapy, 5-FU interstitial chemotherapy, radiotherapy, chemotherapy and transcatheter arterial infusion chemotherapy) and no cancer-directed treatment group (including cases receiving biopsies or bypass). Median survival of three groups were 14.0, 8.3 and 6.6 months respectively. And the 1-year survival rates were 53.5%, 22.5% and 11.8% respectively while the 5-year survival rate 5.8%, 0 and 0 respectively. (4) Median survival of poor prognostic cases (who suffered from weightloss or back pain or whose CA19-9 was above 37 U/ml or whose TNM stage was III/IV) treated with pancreatectomy were 12.0, 11.0, 12.0 and 7.0 months respectively. Median survival of poor prognostic cases treated with cancer-directed therapy were 7.7, 7.5, 8.6 and 8.0 months respectively. Median survival of poor prognostic cases treated with no cancer-directed therapy were 4.0, 3.0, 4.0 and 4.6 months respectively.
Optimized combined therapy is recommended for pancreatic cancer patients with poor prognostic factors.
分析联合治疗在预后较差的胰腺癌中的价值。
回顾性分析不同临床病理特征及治疗方式的胰腺癌预后因素，采用Kaplan-Meier法绘制累积曲线。
（1）2001年1月至2005年12月，分析了233例经病理和细胞学诊断的胰腺癌患者。所有患者的中位生存期为8.67个月，1年生存率为29.6%，5年生存率为4.5%。（2）体重减轻患者的中位生存期为7.7个月，未体重减轻患者为10.0个月（P = 0.003）。背痛患者的中位生存期为6.5个月，无背痛患者为9.0个月（P = 0.015）。CA19-9水平正常（≤37 U/ml）的患者中位生存期为11.0个月，CA19-9＞37 U/ml的患者为8.0个月（P = 0.000）。Ⅲ期和Ⅳ期疾病患者的中位生存期分别为8.7和6.3个月，Ⅰ + Ⅱ期患者为16.0个月（P = 0.000）。在本研究中，体重减轻或背痛或CA19-9高于37 U/ml或TNM分期为Ⅲ/Ⅳ期的患者被定义为预后较差的病例。（3）患者分为胰腺切除术组、针对癌症的治疗组（包括术中碘-125粒子组织间近距离放疗、5-FU组织间化疗、放疗、化疗和经导管动脉灌注化疗）和无针对癌症的治疗组（包括接受活检或旁路手术的病例）。三组的中位生存期分别为14.0、8.3和6.6个月。1年生存率分别为53.5%、22.5%和11.8%，5年生存率分别为5.8%、0和0。（4）接受胰腺切除术的预后较差病例（体重减轻或背痛或CA19-9高于37 U/ml或TNM分期为Ⅲ/Ⅳ期）的中位生存期分别为12.0、11.0、12.0和7.0个月。接受针对癌症治疗的预后较差病例的中位生存期分别为7.7、7.5、8.6和8.0个月。未接受针对癌症治疗的预后较差病例的中位生存期分别为4.0、3.0、4.0和4.6个月。
对于具有不良预后因素的胰腺癌患者，建议采用优化的联合治疗。
