Kalser M H, Barkin J, MacIntyre J M
Cancer. 1985 Jul 15;56(2):397-402. doi: 10.1002/1097-0142(19850715)56:2<397::aid-cncr2820560232>3.0.co;2-i.
Three hundred ninety-three patients who were entered into pancreatic carcinoma treatment protocols of the Gastrointestinal Tumor Study Group (GITSG) were analyzed as to significant differences in clinical presentation and factors influencing survival. Patients were grouped according to the stage of the disease. Group I (21 cases) included those patients who had a potentially curative resection. Group II (182 cases) patients had a locally unresectable tumor less then 400 cm2 (surgically proven) and no distant metastases, and Group III (190 cases) had advanced disease. Group I patients had the smallest lesions (median area, 9 cm2), located in head of the gland in 90% and painless jaundice was the most frequent clinical presentation (52%). In Group II, 83% were located in the head of the gland but the median area was much larger (36 cm2). Pain was present in 80% of cases, and jaundice in 62% with 48% having jaundice and pain. In Group III patients, lesions of body and tail were over four-fold as frequent as in Group I and almost three-fold greater than in Group II. The median area of the lesion was large (30 cm2). Pain was present in 85% and jaundice in only 31%. Median survival in Group I patients was longer than Group III (73 versus 10 weeks; P less than 0.001). Ambulatory status, sex, race, abdominal pain, and histologic type influenced survival in one or more groups whereas age, jaundice, location of the tumor, degree of cellular differentiation, back pain, and nutritional status did not influence survival in any group. In all groups, those with a good performance status (Eastern Cooperative Oncology Group [ECOG] 0 and 1) survived longer than those with poor status (ECOG 2 and 3; P less than 0.05). The best potential prognosis is in those who are fully productive and present with painless jaundice, and who have resection of the tumor.
对393例纳入胃肠道肿瘤研究组（GITSG）胰腺癌治疗方案的患者，分析其临床表现的显著差异及影响生存的因素。患者按疾病分期分组。第一组（21例）包括那些有可能进行根治性切除的患者。第二组（182例）患者有局部不可切除的肿瘤，面积小于400平方厘米（经手术证实）且无远处转移，第三组（190例）有晚期疾病。第一组患者的病变最小（中位面积9平方厘米），90%位于胰头，最常见的临床表现是无痛性黄疸（52%）。在第二组中，83%位于胰头，但中位面积大得多（36平方厘米）。80%的病例有疼痛，62%有黄疸，48%既有黄疸又有疼痛。在第三组患者中，体部和尾部病变的发生率是第一组的四倍多，几乎是第二组的三倍。病变的中位面积较大（30平方厘米）。85%有疼痛，仅有31%有黄疸。第一组患者的中位生存期长于第三组（73周对10周；P<0.001）。活动状态、性别、种族、腹痛和组织学类型在一个或多个组中影响生存，而年龄、黄疸、肿瘤位置、细胞分化程度、背痛和营养状况在任何组中均不影响生存。在所有组中，体能状态良好（东部肿瘤协作组[ECOG]0和1）的患者比体能状态差（ECOG 2和3）的患者生存期长（P<0.05）。最佳的潜在预后见于那些功能完全正常、表现为无痛性黄疸且肿瘤已切除的患者。
