PANCREATICODUODENECTOMY FOR CANCER OF THE HEAD OF THE PANCREAS - 201 PATIENTS
PANCREATICODUODENECTOMY FOR CANCER OF THE HEAD OF THE PANCREAS - 201 PATIENTS
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DOI：
10.1097/00000658-199506000-00011
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发表时间：
1995-06-01
影响因子：
9
通讯作者：
PITT, HA
中科院分区：
文献类型：
--
作者：
YEO, CJ;CAMERON, JL;PITT, HA
目的探讨胰头腺癌患者行胰十二指肠切除术后的预后。近年来，胰头腺癌的胰十二指肠切除术与发病率和死亡率降低有关，在一些中心，5年生存率超过20%。方法对1970 ~ 1994年在约翰霍普金斯医院行胰十二指肠切除术的经病理证实的胰头腺癌患者201例进行回顾性分析（后100例为1991年3月~ 1994年4月）。这是迄今为止报告的最大的单一机构经验。结果149例患者术后住院死亡率为0.7%，术后住院总死亡率为5%。201例患者的精算5年生存率为21%，中位生存期为15.5个月。11例5年存活。切除阴性切缘的患者（治愈性切除：n = 143）精算5年生存率为26%，中位生存期为18个月，而切除阳性切缘的患者（缓和性切除：n = 58）的精算5年生存率为8%，中位生存期为10个月（p < 0.0001）。每十年生存率显著提高（p < 0.002）， 70年代的5年精算生存率为14%，80年代为21%，90年代为36%。单因素分析显著有利于长期生存的因素包括肿瘤直径< 3cm，阴性淋巴结状态，二倍体肿瘤DNA含量，肿瘤S期分数< 18%，保留幽门切除，术中出血量< 800 mt，输血< 2单位，切除边缘阴性，术后辅助化疗和放疗的使用。多因素分析表明，二倍体肿瘤DNA含量、肿瘤直径< 3cm、阴性淋巴结状态、阴性切除边缘和切除十年是长期生存的最强预测因子。结论胰十二指肠切除术可提高胰腺癌患者的生存率。肿瘤生物学方面，如DNA含量、肿瘤直径、淋巴结状态和边缘状态，是预后的最强预测因子。
ObjectiveThis single-institution study examined the outcome after pancreaticoduodenectomy in patients with adenocarcinoma of the head of the pancreas.Summary of Background DataIn recent years, pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas has been associated with decreased morbidity and mortality and, in some centers, 5-year survival rates in excess of 20%.MethodsTwo hundred one patients with pathologically verified adenocarcinoma of the head of the pancreas undergoing pancreaticoduodenectomy at The Johns Hopkins Hospital between 1970 and 1994 were analyzed (the last 100 resections were performed between March 1991 and April 1994). This is the largest single-institution experience reported to date.ResultsThe overall postoperative in-hospital mortality rate was 5%, but has been 0.7% for the last 149 patients. The actuarial 5-year survival for all 201 patients was 21%, with a median survival of 15.5 months. There were 11 5-year survivors. Patients resected with negative margins (curative resections: n = 143) had an actuarial 5-year survival rate of 26%, with a median survival of 18 months, whereas those with positive margins (palliative resections: n = 58) fared significantly worse, with an actuarial 5-year survival rate of 8% and a median survival of 10 months (p < 0.0001). Survival has improved significantly from decade to decade p < 0.002), with the 5-year actuarial survival of 14% in the 1970s, 21% in the 1980s, and 36% in the 1990s. Factors significantly favoring long-term survival by univariate analyses included tumor diameter < 3 cm, negative nodal status, diploid tumor DNA content, tumor S phase fraction < 18%, pylorus preserving resection, < 800 mt intraoperative blood loss, < 2 units of blood transfused, negative resection margins, and use of postoperative adjuvant chemotherapy and radiation therapy. Multivariate analyses indicated the strongest predictors of long-term survival were diploid tumor DNA content, tumor diameter < 3 cm, negative nodal status, negative resection margins, and decade of resection.ConclusionsThe survival of patients with pancreatic adenocarcinoma treated by pancreaticoduodenectomy is improving. Aspects of tumor biology, such as DNA content, tumor diameter, nodal status and margin status, are the strongest predictors of outcome.