Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Med J Aust. 2012 May 7;196(8):511-5. doi: 10.5694/mja11.10890.
To describe the management and outcomes of a population-based cohort of patients with pancreatic cancer in Victoria, Australia.
DESIGN, SETTING AND PATIENTS: Retrospective study based on questionnaires completed from medical histories of patients diagnosed with pancreatic cancer during 2002-2003 in Victoria who were identified from the Victorian Cancer Registry and followed up for 6 years.
Proportion of patients receiving each form of treatment, 30-day mortality, median survival, and 5-year and 6-year survival.
Of 1044 patients with pancreatic cancer identified, 927 were eligible for the study, and questionnaires were completed for 830 (response rate, 89.5%); 67 patients with ampulla of Vater and neuroendocrine tumours were excluded. Of the 763 remaining patients (median age, 72 years), notification of death was available for 747 (97.9%). Most patients (n = 548) had tumours in the head and neck of the pancreas. Resection was performed in a total of 87 patients (11.4%). Patients managed with Whipple resection (n = 75) had a 30-day mortality rate of 5.3% and median survival of 16.3 months. A relatively large number of surgeons (n = 31) each performed a modest number of Whipple resections during the study period. Jaundice was palliated with biliary stents (n = 240) and bypass surgery (n = 99). Survival was shortest in those treated with best supportive care (median, 2.3 months for those with head and neck of pancreas tumours, and 3.4 months for body and tail of pancreas tumours). Of the 20 patients who survived to 5 years, 10 did not have histological confirmation of carcinoma and were presumably false-positive diagnoses, and three of the 10 patients who did have positive histological results had experienced recurrent disease by 6-year follow-up.
Most outcomes in Victoria compared favourably with other studies. Prognosis for patients with carcinoma of the pancreas is grim, with few long-term survivors. Six-year survival appears to be a better proxy for cure than 5-year survival.
描述澳大利亚维多利亚州基于人群的胰腺癌患者队列的管理和结局。
设计、地点和患者：回顾性研究，基于 2002-2003 年期间在维多利亚癌症登记处确诊为胰腺癌的患者的病历完成的问卷调查，并随访 6 年。
每种治疗形式的患者比例、30 天死亡率、中位生存期、5 年和 6 年生存率。
在确定的 1044 例胰腺癌患者中，有 927 例符合研究条件，对 830 例（应答率 89.5%）完成了问卷调查；排除了壶腹和神经内分泌肿瘤的 67 例患者。在其余 763 例患者中（中位年龄 72 岁），有 747 例（97.9%）的死亡通知可用。大多数患者（n=548）的胰腺头颈部有肿瘤。共有 87 例（11.4%）患者接受了手术。接受胰十二指肠切除术的患者（n=75）30 天死亡率为 5.3%，中位生存期为 16.3 个月。在研究期间，相对较多的外科医生（n=31）每人只进行了少量的胰十二指肠切除术。240 例患者采用胆道支架姑息性缓解黄疸，99 例患者采用旁路手术。采用最佳支持治疗的患者生存期最短（胰腺头颈部肿瘤患者中位生存期为 2.3 个月，胰腺体尾部肿瘤患者为 3.4 个月）。20 例存活 5 年的患者中，10 例没有组织学证实的癌，可能是假阳性诊断，而在 10 例有阳性组织学结果的患者中，有 3 例在 6 年随访时已出现复发疾病。
维多利亚州的大多数结果与其他研究相比都较好。胰腺癌患者的预后极差，长期生存者寥寥无几。6 年生存率似乎比 5 年生存率更能反映治愈情况。
