Takahara Naminatsu, Isayama Hiroyuki, Nakai Yousuke, Sasaki Takashi, Saito Kei, Hamada Tsuyoshi, Mizuno Suguru, Miyabayashi Koji, Mohri Dai, Kogure Hirofumi, Matsubara Saburo, Yamamoto Natsuyo, Hirano Kenji, Ijichi Hideaki, Tateishi Keisuke, Tada Minoru, Koike Kazuhiko
From the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Pancreas. 2015 Apr;44(3):380-5. doi: 10.1097/MPA.0000000000000290.
Malignant ascites (MA) caused by peritoneal carcinomatosis is not uncommon in patients with pancreatic cancer. However, the clinical features and outcomes in these patients remain to be elucidated.
Baseline characteristics and overall survival (OS) of consecutive patients with advanced pancreatic cancer who presented with MA were retrospectively evaluated.
Of 494 patients with advanced pancreatic cancer, 73 (15%) presented with MA. Patients with synchronous MA (n = 21), compared with those with metachronous MA (n = 52), had better performance status (P = 0.02), smaller amount of ascites (P < 0.01), and higher chance of receiving chemotherapy (57% vs 17%, P < 0.01), and resulted in longer OS (115 vs 42 days, P < 0.01). Overall survival was significantly longer in patients receiving chemotherapy than in those with best supportive care alone (124 vs 50 days, P < 0.01). In a multivariate analysis, chemotherapy was prognostic in addition to performance status, CRP, and small amount of MA; the hazard ratio of chemotherapy was 0.46, compared with best supportive care alone (P = 0.02).
Although the prognosis of pancreatic cancer patients with MA remains poor, selected patients may be candidate for chemotherapy, regardless of the timing of appearance of MA.
腹膜癌病引起的恶性腹水（MA）在胰腺癌患者中并不少见。然而，这些患者的临床特征和预后仍有待阐明。
回顾性评估连续出现MA的晚期胰腺癌患者的基线特征和总生存期（OS）。
在494例晚期胰腺癌患者中，73例（15%）出现MA。同步性MA患者（n = 21）与异时性MA患者（n = 52）相比，体能状态更好（P = 0.02），腹水量更少（P < 0.01），接受化疗的机会更高（57%对17%，P < 0.01），且总生存期更长（115天对42天，P < 0.01）。接受化疗的患者总生存期明显长于仅接受最佳支持治疗的患者（124天对50天，P < 0.01）。在多变量分析中，除体能状态、CRP和少量MA外，化疗具有预后意义；与仅接受最佳支持治疗相比，化疗的风险比为0.46（P = 0.02）。
尽管伴有MA的胰腺癌患者预后仍然很差，但部分患者可能是化疗的候选对象，无论MA出现的时间。
