根治性切除术后门静脉系统受侵胰腺癌的预后分析
Prognostic analysis of pancreatic carcinoma with portal system invasion following curative resection.
作者信息
Wang Jing, Lyu Shao-Cheng, Zhou Lin, Wang Han, Pan Fei, Jiang Tao, Lang Ren, He Qiang
机构信息
Department of Hepatobiliary and Pancreatic Splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
出版信息
Gland Surg. 2021 Jan;10(1):35-49. doi: 10.21037/gs-20-495.
BACKGROUND
To analyze the related factors affecting the prognosis of pancreatic carcinoma with portal system invasion.
METHODS
We retrospectively analyzed the clinical data of 118 patients with portal venous system invasion in Beijing Chaoyang Hospital between January 2011 and December 2018. Only patients with borderline resectable pancreatic cancer were included in this study. Borderline pancreatic cancer was defined according to NCCN (The National Comprehensive Cancer Network) guidelines. All patients underwent surgical treatment combined with vascular resection and reconstruction. The prognosis was evaluated according to the follow-up results, and the related risk factors for prognosis were analyzed. The survival curve was drawn by Kaplan-Meier method, and the survival rate was compared by log-rank test. Multivariate Cox regression was used to analyze the prognostic factors.
RESULTS
In our research, all of 126 patients were successfully completed the operations. Complications occurred in 29.7% of patients and perioperative death in 4.0%. A total of 118 patients were followed up and the followed-up rate was 97.5% (118/121). The overall 1-year, 2-year and 3-year survival rates were 49.2%, 27.1% and 19.8%, And the median survival time was 20 months. Multivariate analysis showed that preoperative CA19-9 (RR 1.449, 95% CI: 1.053-1.994), N status (RR 2.533, 95% CI: 1.337-4.798), degree of tumor differentiation (RR 1.592, 95% CI: 1.064-2.381) and venous invasion depth (RR 2.03, 95% CI: 1.504-2.758) were independent risk factors for the prognosis.
CONCLUSIONS
The long-term prognosis of pancreatic carcinoma patients with portal system invasion is poor. The venous invasion depth is an independent risk factor for the prognosis of pancreatic carcinoma with portal system invasion, the deeper of venous invasion, the worse the prognosis, and poorly differentiated tumors have the worst prognosis. Other independent risk factors included N status and the preoperative CA19-9. Those may help with patients' selection for different treatment protocols.
背景
分析影响门静脉系统受侵胰腺癌预后的相关因素。
方法
回顾性分析2011年1月至2018年12月在北京朝阳医院接受治疗的118例门静脉系统受侵患者的临床资料。本研究仅纳入可切除边缘性胰腺癌患者。边缘性胰腺癌根据美国国立综合癌症网络（NCCN）指南定义。所有患者均接受手术治疗并联合血管切除及重建。根据随访结果评估预后，并分析预后相关危险因素。采用Kaplan-Meier法绘制生存曲线，采用log-rank检验比较生存率。采用多因素Cox回归分析预后因素。
结果
本研究中，126例患者均成功完成手术。29.7%的患者发生并发症，围手术期死亡率为4.0%。共118例患者获得随访，随访率为97.5%（118/121）。1年、2年和3年总生存率分别为49.2%、27.1%和19.8%，中位生存时间为20个月。多因素分析显示，术前CA19-9（风险比[RR]1.449，95%置信区间[CI]：1.053 - 1.994）、N分期（RR 2.533，95% CI：1.337 - 4.798）、肿瘤分化程度（RR 1.592，95% CI：1.064 - 2.381）和静脉侵犯深度（RR 2.03，95% CI：1.504 - 2.758）是预后的独立危险因素。
结论
门静脉系统受侵胰腺癌患者的长期预后较差。静脉侵犯深度是门静脉系统受侵胰腺癌预后的独立危险因素，静脉侵犯越深，预后越差，低分化肿瘤预后最差。其他独立危险因素包括N分期和术前CA19-9。这些因素有助于为患者选择不同的治疗方案。
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