Yamamoto Takehito, Yagi Shintaro, Kinoshita Hiromitsu, Sakamoto Yusuke, Okada Kazuyuki, Uryuhara Kenji, Morimoto Takeshi, Kaihara Satoshi, Hosotani Ryo
Takehito Yamamoto, Shintaro Yagi, Hiromitsu Kinoshita, Yusuke Sakamoto, Kazuyuki Okada, Kenji Uryuhara, Satoshi Kaihara, Ryo Hosotani, Department of Surgery, Kobe City Medical Center General Hospital, Hyogo 650-0047, Japan.
World J Gastroenterol. 2015 Jan 7;21(1):262-8. doi: 10.3748/wjg.v21.i1.262.
To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.
From January 2000 to December 2011, 195 patients underwent pancreatic resection in our hospital. The prognostic factors after pancreatic resection were analyzed in all 195 patients. After excluding the censored cases within an observational period, the clinicopathological characteristics of 20 patients who survived ≥ 5 (n = 20) and < 5 (n = 76) years were compared. For this comparison, we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years. For statistical analyses, the log-rank test was used to compare the cumulative survival rates, and the χ (2) and Mann-Whitney tests were used to compare the two groups. The Cox-Hazard model was used for a multivariate analysis, and P values less than 0.05 were considered significant. A multivariate analysis was conducted on the factors that were significant in the univariate analysis.
The median survival for all patients was 27.1 months, and the 5-year actuarial survival rate was 34.5%. The median observational period was 595 d. With the univariate analysis, the UICC stage was significantly associated with survival time, and the CA19-9 ≤ 200 U/mL, DUPAN-2 ≤ 180 U/mL, tumor size ≤ 20 mm, R0 resection, absence of lymph node metastasis, absence of extrapancreatic neural invasion, and absence of portal invasion were favorable prognostic factors. The multivariate analysis showed that tumor size ≤ 20 mm (HR = 0.40; 95%CI: 0.17-0.83, P = 0.012) and negative surgical margins (R0 resection) (HR = 0.48; 95%CI: 0.30-0.77, P = 0.003) were independent favorable prognostic factors. Among the 96 patients, 20 patients survived for 5 years or more, and 76 patients died within 5 years after operation. Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2 (79.5 vs 312.5 U/mL, P = 0.032), tumor size ≤ 20 mm (35% vs 8%, P = 0.008), R0 resection (95% vs 61%, P = 0.004), and absence of lymph node metastases (60% vs 18%, P = 0.036) were significantly associated with the 5-year survival.
Negative surgical margins and a tumor size ≤ 20 mm were independent favorable prognostic factors. Histologically curative resection and early tumor detection are important factors in achieving long-term survival.
回顾性分析影响接受胰腺切除术的胰腺癌患者长期生存的因素。
2000年1月至2011年12月，我院195例患者接受了胰腺切除术。对全部195例患者胰腺切除术后的预后因素进行分析。在排除观察期内的删失病例后，比较生存≥5年（n = 20）和＜5年（n = 76）的20例患者的临床病理特征。为进行该比较，我们分析了2008年6月前接受手术且观察超过5年的患者。统计分析采用对数秩检验比较累积生存率，χ²检验和曼-惠特尼检验比较两组。采用Cox风险模型进行多因素分析，P值小于0.05被认为具有统计学意义。对单因素分析中有统计学意义的因素进行多因素分析。
所有患者的中位生存期为27.1个月，5年精算生存率为34.5%。中位观察期为595天。单因素分析显示，UICC分期与生存时间显著相关，CA19-9≤200 U/mL、DUPAN-2≤180 U/mL、肿瘤大小≤20 mm、R0切除、无淋巴结转移、无胰腺外神经侵犯及无门静脉侵犯是有利的预后因素。多因素分析显示，肿瘤大小≤20 mm（HR = 0.40；95%CI：0.17 - 0.83，P = 0.012）和手术切缘阴性（R0切除）（HR = 0.48；95%CI：0.30 - 0.77，P = 0.003）是独立的有利预后因素。96例患者中，20例存活5年以上，76例术后5年内死亡。将20例5年生存者与76例非生存者比较显示，较低的DUPAN-2浓度（79.5 vs 312.5 U/mL，P = 0.032）、肿瘤大小≤20 mm（35% vs 8%，P = 0.008）、R0切除（95% vs 61%，P = 0.004）及无淋巴结转移（60% vs 18%，P = 0.036）与5年生存显著相关。
手术切缘阴性和肿瘤大小≤20 mm是独立的有利预后因素。组织学上的根治性切除和早期肿瘤检测是实现长期生存的重要因素。
