Kelsen D P, Portenoy R, Thaler H, Tao Y, Brennan M
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Surgery. 1997 Jul;122(1):53-9. doi: 10.1016/s0039-6060(97)90264-6.
The purpose of our study was to evaluate the relationship between pain and resectability and survival in patients with operable pancreatic carcinoma.
Pain, pain intensity, and pain location were prospectively assessed in newly diagnosed patients with operable adenocarcinoma of the pancreas. Patients were evaluated before their first operation at a large tertiary care cancer center. Pain factors were then correlated with outcomes of surgery, including resectability and survival.
Seventy-seven patients with operable pancreatic carcinoma were evaluated before operation. With the Memorial Pain Assessment Card and a demographic questionnaire, an analysis of analgesic use and pain prevalence and intensity were quantitated. Twenty-two (29%) of 77 patients reported no pain. Fifty-five had mild to severe pain. Moderately severe or greater pain (Memorial Pain Assessment Card Tursky scores of 5 or greater or visual analogue self-assessment pain intensity scores greater than 30) was found in 20 patients. Twenty-six (34%) patients had resectable disease. Of the 51 patients who did not have resections, 35 had metastatic disease. Locoregional unresectable disease without metastases was found in 16 patients. Resectability was correlated with the presence of pain (p = 0.04). The median survival for all patients was 6.7 months. Not surprisingly, patients undergoing resection had a significantly better median survival than did those whose disease was unresectable (5.5 versus 15.1 months). Pain before operation significantly predicted survival (median survival for those with pain, 5.7 months; for those without pain, 15 months; p = 0.003). Even among patients who underwent resection, the presence of pain was associated with a worse survival (21.9 months versus 9.2 months; p = 0.045). In a multivariate analysis the two significant variables were inability to undergo resection and presence of any pain.
The presence of pain in newly diagnosed patients with potentially operable pancreatic cancer is an ominous predictor of resectability and of survival. Even if the patient can undergo resection, the presence of preoperative pain is associated with a poor prognosis. Patients with operable pancreatic cancer who present with pain, even those whose evaluation shows a likelihood of resectability, are at high risk for recurrence with an impaired survival compared with those patients without pain.
我们研究的目的是评估可手术切除的胰腺癌患者疼痛与可切除性及生存率之间的关系。
对新诊断的可手术切除的胰腺腺癌患者进行前瞻性疼痛、疼痛强度及疼痛部位评估。患者在一家大型三级医疗癌症中心首次手术前接受评估。然后将疼痛因素与手术结果相关联，包括可切除性和生存率。
77例可手术切除的胰腺癌患者在手术前接受了评估。使用纪念疼痛评估卡和一份人口统计学调查问卷，对镇痛药物使用情况以及疼痛发生率和强度进行了定量分析。77例患者中有22例（29%）报告无疼痛。55例有轻至重度疼痛。20例患者存在中度至重度或更严重疼痛（纪念疼痛评估卡Tursky评分5分及以上或视觉模拟自评疼痛强度评分大于30分）。26例（34%）患者疾病可切除。在51例未进行手术切除的患者中，35例有转移性疾病。16例患者存在无转移的局部区域不可切除疾病。可切除性与疼痛的存在相关（p = 0.04）。所有患者的中位生存期为6.7个月。不出所料，接受手术切除的患者中位生存期明显优于疾病不可切除的患者（5.5个月对15.1个月）。术前疼痛显著预测生存率（有疼痛者中位生存期为5.7个月；无疼痛者为15个月；p = 0.003）。即使在接受手术切除的患者中，疼痛的存在也与较差的生存率相关（21.9个月对9.2个月；p = 0.045）。在多变量分析中，两个显著变量是无法进行手术切除和存在任何疼痛。
新诊断的潜在可手术切除的胰腺癌患者存在疼痛是可切除性和生存率的不祥预测指标。即使患者能够接受手术切除，术前疼痛的存在也与预后不良相关。有疼痛表现的可手术切除的胰腺癌患者，即使那些评估显示有可切除可能性的患者，与无疼痛的患者相比，复发风险高且生存率受损。
