Clinicopathologic evaluation after resection for ductal adenocarcinoma of the pancreas: A retrospective, single-institution experience
Clinicopathologic evaluation after resection for ductal adenocarcinoma of the pancreas: A retrospective, single-institution experience
复制标题
DOI：
10.1097/00006676-200304000-00007
复制
发表时间：
2003-04-01
期刊：
影响因子：
2.9
通讯作者：
Kamiyama, Y
中科院分区：
文献类型：
--
作者：
Takai, S;Satoi, S;Kamiyama, Y
前言：1992年4月至2000年12月，167例胰腺癌患者在我科进行了评估和治疗。108例（64.7%）胰腺癌患者接受了胰腺切除术。在这些患者中，94例经组织学证实为导管腺癌。总体术后死亡率为3.2%（3例患者），发病率为35.1%（33例患者）。估计1、2、3和5年生存率分别为43.6%、28.7%、21.8%和12.9%。只有6名长期存活者在手术后存活超过5年。方法和目标：回顾了94例连续接受胰腺切除术的导管腺癌患者的机构经验，以阐明29个预后因素（5个宿主，17个肿瘤和7个治疗因素）的影响。特别提到的是，以确定这些重要因素是否对长期生存的影响。采用单因素和多因素模型分析预后因素对生存的影响。结果如下：单因素分析显示出血量、手术时间、术后并发症、组织病理学淋巴和静脉浸润、淋巴结转移、最终分期、最终治愈率、切缘、浆膜浸润、肿瘤大小、腹膜后浸润、主要动脉浸润和组织学浸润方式与生存期显著延长相关（p < 0.05）。通过考克斯比例风险生存分析，最有力的预后预测因子是静脉渗透、淋巴结转移、肿瘤直径和确定的可治愈性。存活时间最长的患者为最晚期（IVb期），可治愈性为C。根据多因素分析，没有长期存活者具有所有良好的预后因素。结论：胰腺癌手术切除后的预后主要取决于肿瘤因素。在这项研究中，很难确定可切除肿瘤患者长期生存的决定因素。
Introduction: Between April 1992 and December 2000, 167 patients with pancreatic carcinoma were evaluated and treated in our department. One hundred eight patients (64.7%) with pancreatic carcinoma underwent pancreatectomy. Of these patients, 94 had histologically proven ductal adenocarcinoma. The overall postoperative mortality rate was 3.2% (3 patients), and the morbidity rate was 35.1% (33 patients). The estimated 1-, 2-, 3-, and 5-year survival rates were 43.6%, 28.7%, 21.8%, and 12.9%, respectively. There were only six long-term survivors who survived >5 years after surgery. Methodology and Aims: Institutional experience with 94 consecutive patients with ductal adenocarcinoma who underwent pancreatectomy was reviewed to clarify the influence of 29 prognostic factors (5 host, 17 tumor, and 7 treatment factors). Special reference was made to determine whether these significant factors have an effect on long-term survival. Univariate and multivariate models were used to analyze the effect of prognostic factors on survival. Results: Univariate analysis indicated that blood loss, operative time, postoperative complications, histopathologic lymphatic and venous permeation, lymph node metastasis, conclusive stage, conclusive curability, resection margins, serosal invasion, size of tumor, retroperitoneal invasion, major arterial invasion, and mode of histologic infiltration were associated with significantly longer survival (p < 0.05). By Cox proportional hazards survival analysis, the most powerful predictors of outcome were venous permeation, lymph node metastasis, tumor diameter, and conclusive curability. The longest-term survivor had the most advanced stage (stage IVb) of disease and curability C. No longterm survivors had all of the good prognostic factors (according to multivariate analysis). Conclusions: The prognosis after surgical resection of pancreatic carcinoma mostly depends on tumor factors. In this study, it was difficult to identify the determinants of long-term survival in patients with resectable tumors.