Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University in St Louis, St Louis, MO, USA; Alvin J. Siteman Cancer Center, Washington University in St Louis, St Louis, MO, USA.
HPB (Oxford). 2014 Feb;16(2):150-6. doi: 10.1111/hpb.12094. Epub 2013 Apr 22.
Jaundice impairs cellular immunity, an important defence against the dissemination of cancer. Jaundice is a common mode of presentation in pancreatic head adenocarcinoma. The purpose of this study was to determine whether there is an association between preoperative jaundice and survival in patients who have undergone resection of such tumours.
Thirty possible survival risk factors were evaluated in a database of over 400 resected patients. Univariate analysis was used to determine odds ratio for death. All factors for which a P-value of <0.30 was obtained were entered into a multivariate analysis using the Cox model with backward selection.
Preoperative jaundice, age, positive node status, poor differentiation and lymphatic invasion were significant indicators of poor outcome in multivariate analysis. Absence of jaundice was a highly favourable prognostic factor. Interaction emerged between jaundice and nodal status. The benefit conferred by the absence of jaundice was restricted to patients in whom negative node status was present. Five-year overall survival in this group was 66%. Jaundiced patients who underwent preoperative stenting had a survival advantage.
Preoperative jaundice is a negative risk factor in adenocarcinoma of the pancreas. Additional studies are required to determine the exact mechanism for this effect.
黄疸会损害细胞免疫，这是抵抗癌症扩散的重要防御机制。黄疸是胰头腺癌的常见表现形式。本研究旨在确定在接受此类肿瘤切除的患者中，术前黄疸与生存之间是否存在关联。
在超过 400 例接受切除手术的患者的数据库中，评估了 30 个可能的生存风险因素。使用单因素分析确定死亡的优势比。对于所有 P 值<0.30 的因素，使用 Cox 模型进行多因素分析，采用向后选择法。
术前黄疸、年龄、阳性淋巴结状态、低分化和淋巴浸润是多因素分析中预后不良的显著指标。无黄疸是一个非常有利的预后因素。黄疸和淋巴结状态之间存在交互作用。无黄疸带来的益处仅限于淋巴结状态阴性的患者。该组患者的 5 年总生存率为 66%。接受术前支架置入术的黄疸患者具有生存优势。
术前黄疸是胰腺腺癌的负风险因素。需要进一步研究以确定这种影响的确切机制。
