Sperti C, Pasquali C, Piccoli A, Pedrazzoli S
Department of Surgery, University of Padua, Padua, Italy.
World J Surg. 1997 Feb;21(2):195-200. doi: 10.1007/s002689900215.
We analyzed the pattern of failure and clinicopathologic factors influencing the disease-free survival of 78 patients who died after macroscopic curative resection for pancreatic cancer. Local recurrence was a component of failure in 56 patients (71.8%) and hepatic recurrence in 48 (61.5%), both accounting for 97% of the total recurrence rate. About 95% of recurrences occurred by 24 months after operation. Median disease-free survival time was 8 months, and cumulative 1-, 3-, and 5-year actuarial disease-free survival rates were 66%, 7%, and 3%, respectively. Multivariate analysis showed that tumor grade (p = 0.04), microscopic radicality of resection (p = 0.04), lymph node status (p = 0.01), and size of the tumor (p = 0.005) were independent predictors of disease-free survival. Patterns of failure and disease-free survival were not statistically influenced by the type of surgical procedure performed. Median survival time from the detection of recurrence until death was 7 months for local recurrence versus 3 months for hepatic or local plus hepatic recurrence (p < 0.05). From our experience and the data collected from the literature, it appears that surgery alone is an inadequate treatment for cure in patients with pancreatic carcinoma. Effective adjuvant therapies are needed to improve locoregional control of pancreatic cancer after surgical resection.
我们分析了78例胰腺癌患者在接受宏观根治性切除术后死亡的失败模式及影响无病生存期的临床病理因素。局部复发是56例患者（71.8%）失败的组成部分，肝转移复发是48例患者（61.5%）失败的组成部分，两者占总复发率的97%。约95%的复发发生在术后24个月内。无病生存期的中位数为8个月，1年、3年和5年的累积无病生存率分别为66%、7%和3%。多因素分析显示，肿瘤分级（p = 0.04）、切除的显微镜下根治性（p = 0.04）、淋巴结状态（p = 0.01）和肿瘤大小（p = 0.005）是无病生存期的独立预测因素。失败模式和无病生存期不受所施行手术方式的统计学影响。局部复发患者从复发检测到死亡的中位生存时间为7个月；肝转移或局部加肝转移复发患者为3个月（p < 0.05）。根据我们的经验以及从文献中收集的数据，对于胰腺癌患者而言，似乎单纯手术不足以实现治愈。需要有效的辅助治疗来改善胰腺癌手术切除后的局部区域控制。
