中国普通外科杂志 ›› 2021, Vol. 30 ›› Issue (3): 247-253.doi: 10.7659/j.issn.1005-6947.2021.03.001

• 专题研究 •    下一篇

预后指数在可切除胰腺导管腺癌患者术后评估中临床价值

韩仕锋,金春风,朱磊   

  1. (辽宁省盘锦辽油宝石花医院 普通外科,辽宁 盘锦 124010)
  • 收稿日期:2020-07-31 修回日期:2021-02-19 出版日期:2021-03-25 发布日期:2021-04-06
  • 通讯作者: 朱磊, Email: zhulei19862012@126.com
  • 作者简介:韩仕锋,辽宁省盘锦辽油宝石花医院副主任医师,主要从事普通外科疾病方面的研究。

Clinical value of prognostic index in postoperative evaluation of patients with resectable pancreatic ductal adenocarcinoma

HAN Shifeng, JIN Chunfeng, ZHU Lei   

  1. (Department of General Surgery, Panjin Liao-Oil Gem Flower Hospital, Panjin, Liaoning 124010, China)
  • Received:2020-07-31 Revised:2021-02-19 Online:2021-03-25 Published:2021-04-06

摘要: 背景与目的:肿瘤相关性炎症反应不仅具有促进肿瘤增殖、维持和转移作用,还在肿瘤血管生成、适应性免疫失调以及抑制化疗反应过程中起着至关重要作用。目前已建立多项基于炎症标记物的特异度评分系统,部分标记物已作为恶性肿瘤患者治疗反应和结果的预后评估指标。本研究旨在确定预后指数(PI)对胰腺导管腺癌(PDAC)患者远期预后评估的临床价值。
方法:回顾性分析2011年1月—2014年12月在盘锦辽油宝石花医院接受胰腺切除的PDAC患者112例临床资料。收集术前C反应蛋白水平和白细胞计数计算PI,比较不同PI分级(0、1、2级)患者临床病理特征与生存率的差异,并分析影响PDAC患者的术后生存的危险因素。
结果:112例患者中PI 0级37例、1级51例、2级24例。3组患者间基本资料差异无统计学意义(均P>0.05)。临床病理特征分析结果显示,3组患者间术前CA19-9水平、TNM分期、血管受侵方面差异有统计学意义(χ2=10.929、3.029、7.540,均P<0.05),而其他因素包括肿瘤大小、手术方式、肿瘤分化程度、神经受侵、术后并发症、术后辅助化疗等差异均无统计学意义(均P>0.05)。随访时间9~81个月,中位随访时间13个月,随访期间患者死亡103例,存活9例。生存分析结果显示,PI分级越高,5年生存率越低(0级:18.9%、1级:3.9%、2级:0.0%;χ2=9.195,P=0.010)。单因素分析结果表明,肿瘤大小、CA19-9水平、TNM分期、肿瘤分化程度、PI、术后辅助化疗与PDAC患者术后生存明显有关(χ2=4.881,8.377、15.022、5.349、9.195、4.066,均P<0.05);多因素分析结果显示,CA19-9>37 IU/mL(HR=1.639,95% CI=1.073~2.506,P=0.022)、肿瘤TNM为III期(III vs. I:HR=2.210,95% CI=1.229~3.974,P=0.008;II vs. I:HR=1.925,95% CI=1.081~3.426,P=0.026)及PI 2(2 vs. 0:HR=2.083,95% CI=1.190~3.645,P=0.010;1 vs. 0:HR=1.764,95% CI=1.101~2.828,P=0.018)是影响PDAC患者术后生存时间的独立危险因素。
结论:PI是PDAC患者术后预后的独立危险因素,PI分级越高,患者预后越差,但在将PI作为一种预后指标引入临床实践之前,需要进行更大规模的对照试验进行评估。

关键词: 胰腺肿瘤, 胰腺切除术, 预后指数, 预后

Abstract: Background and Aims: Cancer-related inflammation is not only associated with tumor proliferation, maintenance and dissemination, but also is critical for tumor angiogenesis, adaptive immune disorders and impaired chemotherapy response. Accordingly, a number of specific score systems have been established on the basis of inflammatory markers that have been validated as prognosticators for therapy responses and outcomes in patients with solid malignancies. This study was conducted to determine the clinical value of prognostic index (PI) for long-term results in patients with pancreatic ductal adenocarcinoma (PDAC).  
Methods: The clinical data of PDAC patients who received pancreatectomy in the Panjin Liao-Oil Gem Flower Hospital from January 2011 to 2014 December were retrospectively analyzed. The PI scores were calculated via preoperative C-reactive protein levels and white blood cell counts. Among patients with different PI scores (0, 1 and 2), the differences in clinicopathologic characteristics and survival rate were compared. The risk factors for postoperative survival of PDAC patients were also determined.
Results: Of the 112 patients, 37 cases had a PI score 0, 51 cases had a score 1, and 24 cases had a score 2. There were no statistical differences in the basic data among the three groups of patients (all P>0.05). Analysis of clinicopathologic features showed that there were statistical differences among three groups of patients in terms of preoperative CA19-9 level, TNM stage and vascular invasion (χ2=10.929, 3.029, and 7.540, all P<0.05), and no significant differences were noted in tumor size, surgical method, degree of tumor differentiation, nerve invasion, postoperative complications, and postoperative adjuvant chemotherapy (all P>0.05). The follow-up time was 9–81 months, with a median follow-up time of 13 months. During the follow-up period, 103 patients died, and 9 patients survived. The results of survival analysis showed that the 5-year survival rate was decreased with the elevation of PI score (score 0:18.9%, score 1: 3.9% and score 2: 0.0%; χ2=9.195, P=0.010). Univariate analysis showed that tumor size, CA19-9 level, TNM stage, degree of tumor differentiation, PI, and postoperative adjuvant chemotherapy were significantly related to the 5-year survival rate of PDAC patients (χ2=4.881, 8.377, 15.022, 5.349, 9.195, and 4.066, all P<0.05). Multivariate analysis showed that CA19-9 >37 IU/mL (HR=1.639, 95% CI=1.073–2.506, P=0.022), TNM stage III (III vs. I: HR=2.210, 95% CI=1.229–3.974, P=0.008; II vs. I: HR=1.925, 95% CI=1.081–3.426, P=0.026) and PI score 2 (2 vs. 0: HR=2.083, 95% CI=1.190–3.645, P=0.010; 1 vs. 0: HR=1.764, 95% CI=1.101–2.828, P=0.018) were independent risk factors affecting the postoperative survival of PDAC patients.
Conclusion: PI is an independent risk factor for the postoperative prognosis of PDAC patients, and those with a higher PI may have a worse prognosis. However, evaluation in larger controlled studies is needed before introduction of PI into clinical practice as a prognostic indicator. 

Key words: Pancreatic Neoplasms, Pancreatectomy, Prognostic Index, Prognosis

中图分类号: 

  • R735.9
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