Prognostic factors in resected pancreatic adenocarcinoma: Analysis of actual 5-year survivors
Prognostic factors in resected pancreatic adenocarcinoma: Analysis of actual 5-year survivors
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DOI：
10.1016/j.jamcollsurg.2004.01.008
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发表时间：
2004-05-01
影响因子：
5.2
通讯作者：
Gallinger, S
中科院分区：
文献类型：
--
作者：
Cleary, SP;Gryfe, R;Gallinger, S
背景：胰腺癌是一种迅速致命的疾病，即使经过积极的手术治疗，存活5年的人也很少。我们的目标是确定在多伦多大学系统内的5所教学医院接受有治疗意图的胰腺癌切除的患者的实际5年存活率。然后，我们试图确定5年幸存者的临床和组织病理学特征，以确定与良好预后相关的因素。研究设计：使用外科医生和医院数据库进行回顾性图表回顾，以确定在1988年1月1日至1996年12月31日期间接受手术切除的胰腺癌患者。结果：从7个手术实践中确定了123例接受手术并经病理诊断的胰腺癌患者。本组患者的平均生存期(+/-标准差)为31.7+/-3.5个月(中位数13.6个月)。5年生存者18例(14.6%)，其中生存10年以上者5例(4.1%)。幸存者包括13名接受Whiple切除的患者，4名接受远端胰腺切除的患者，1名接受全胰腺切除的患者。在单因素分析中，肿瘤大小、首发时无黄疸、阴性结节、低肿瘤分级和低肿瘤分期都是显著的生存预测因素(均P<；0.05)。仅肿瘤分期(危险比[95%可信区间]：IIA期1.5[0.8至2.8]，IIB期2.6[1.4至4.7]，III期1.8[0.8至4.3])和肿瘤分级(危险比[95%可信区间]：中度分化1.6[0.9至2.9]，和低分化3.1[1.6到6.2]在多变量COX比例风险模型中独立地与生存差异相关。结论：我们得出结论：如果胰腺癌在早期被发现，其长期生存是可能的。这些和其他类似的数据应该为开发和评估新的筛查策略提供进一步的刺激，以改进对这种疾病的早期发现。《外科杂志》2004；198：722-731。(C)2004年由美国外科医师学会主办)
BACKGROUND: Pancreatic cancer is a rapidly fatal disease with very few 5-year survivors even after aggressive surgical treatment. Our objective was to determine the actual 5-year survival rate of patients with pancreatic adenocarcinoma who underwent a resection with curative intent in 5 teaching hospitals within the University of Toronto system. We then sought to determine clinical and histopathologic features of 5-year survivors to determine factors associated with a favorable prognosis.STUDY DESIGN: A retrospective chart review was performed using surgeon and hospital databases to identify patients who had a surgical resection for pancreatic adenocarcinoma between January 1, 1988, and December 31, 1996.RESULTS: One hundred twenty-three patients who had a resection and a pathologic diagnosis of pancreatic adenocarcinoma with complete followup were identified from seven surgical practices. Mean survival (+/- standard error) in this series was 31.7 +/- 3.5 months (median 13.6 months). There were 18 5-year survivors (14.6%), including 5 patients (4.1%) who survived longer than 10 years. The survivors included 13 patients who had undergone a Whipple resection, 4 who had undergone a distal pancreatectomy, and 1 who had undergone a total pancreatectomy. Tumor size, lack of jaundice at presentation, negative nodal disease, low tumor grade, and a low tumor stage were all significant predictors of survival in univariate analysis (all p < 0.05). Only tumor stage (hazard ratio [95% confidence interval]: stage IIA 1.5 [0.8 to 2.8], stage IIB 2.6 [1.4 to 4.7], stage III 1.8 [0.8 to 4.3]) and tumor grade (hazard ratio [95% confidence interval]: moderately differentiated 1.6 [0.9 to 2.9], and poorly differentiated 3.1 [1.6 to 6.2]) were independently associated with survival differences in a multivariate Cox proportional hazards model.CONCLUSIONS: We conclude that longterm survival from pancreatic adenocarcinoma is possible if the disease is identified in its early stages. These and other similar data should provide further stimulus for the development and evaluation of novel screening strategies to improve early detection of this disease. (J Am Coll Surg 2004; 198:722-731. (C) 2004 by the American College of Surgeons)