Kokoska E R, Stapleton D R, Virgo K S, Johnson F E, Wade T P
Department of Surgery, Saint Louis University Health Sciences Center, St. Louis, MO, USA.
Int J Oncol. 1998 Dec;13(6):1323-9. doi: 10.3892/ijo.13.6.1323.
Although resection for pancreatic cancer is occasionally curative, its major value lies in restoring patients to a more normal life. The objective of this study was to evaluate the functional quality of life (QoL) of patients undergoing various treatments for pancreatic cancer using a nationwide, multi-institutional, non-referral patient population. From 822 pancreatic cancer patients treated from 1989 to 1995, and listed in the Department of Defense (DoD) hospital central computerized tumor registry, we selected 781 with evaluable survival information. Local tumor registrars had contacted patients at least yearly and prospectively compiled a QoL index using a self-reported Karnofsky performance status (KPS); values were obtained for patients alive in March of 1995 and/or 1996. Survival duration and KPS scores were then compared by stage and treatment using analysis of variance (F-test). Resection significantly increased KPS and mean survival time with stage I-II cancers and improved mean survival time, but not KPS, in patients with node positive (stage III) disease. The projected five-year survival rate after resection in stages I-II was 24% but zero for stage III. Patients receiving combined chemo- and radiation therapies, whether given as adjuvant or primary treatment, had significantly longer mean survival duration. However, KPS scores were not higher in treated patients. These data indicate that patients live longer and better lives after resection of localized pancreatic cancers, but QoL measurements do not support resection for pancreatic cancer involving lymph nodes. Unresected patients selected for combined chemo- and radiation therapy live longer, but not better, lives.
尽管胰腺癌切除术偶尔可治愈疾病，但其主要价值在于使患者恢复更正常的生活。本研究的目的是利用全国范围内、多机构、非转诊患者群体，评估接受各种胰腺癌治疗的患者的功能生活质量（QoL）。从1989年至1995年接受治疗并列入国防部（DoD）医院中央计算机肿瘤登记处的822例胰腺癌患者中，我们选取了781例具有可评估生存信息的患者。当地肿瘤登记员至少每年与患者联系一次，并使用自我报告的卡诺夫斯基性能状态（KPS）前瞻性编制QoL指数；获取了1995年3月和/或1996年存活患者的值。然后使用方差分析（F检验）按分期和治疗比较生存时间和KPS评分。对于I-II期癌症，切除显著提高了KPS和平均生存时间，对于有淋巴结转移（III期）疾病的患者，切除改善了平均生存时间，但未提高KPS。I-II期切除后的预计五年生存率为24%，但III期为零。接受化疗和放疗联合治疗的患者，无论作为辅助治疗还是主要治疗，平均生存时间显著更长。然而，接受治疗的患者KPS评分并未更高。这些数据表明，局限性胰腺癌切除术后患者寿命更长，生活质量更好，但QoL测量不支持对涉及淋巴结的胰腺癌进行切除。选择接受化疗和放疗联合治疗的未切除患者寿命更长，但生活质量并未更好。
