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目的 探讨提高胰腺癌治愈性切除相关因素和获得更佳疗效。方法 中国抗癌协会胰腺癌专业委员会回顾性分析了8省2市14大医院的1990年-2000年诊治的2340例胰腺病例。多因素生存分析采用Cox比例风险模型找出可能影响胰腺癌病人预后的独立因素。单因素生存分析用寿命表法计算,以生存曲线描述生存率,并进行Gehan比分检验。结果 COX单因素分析表明在a=0.05水平上有意义的有年龄、职业、病程、肿瘤部位、手术方式、术后胰瘘、术后肝衰、化疗、TNM分期、免疫治疗、有无肝转移、肠系膜上血管有无侵犯等变量。COX多因素分析表明在a=0.05水平上有意义的有患者年龄、手术方式、术后胰瘘、术后肝衰、化疗、免疫治疗等变量,这些变量为影响胰腺癌预后的独立因素。根治性手术者相对于未手术者,以及化疗、免疫治疗均为保护性因素。其中40岁以上的占了92.91％,40岁以下的仅占7.09％。胰头癌根治性手术组中位生存时间为 17.11个月,1年、3年和5年生存率分别为54.36％、13.47％、8.47％。结论 有必要将40岁以上的人群视为高危人群,能及时发现早期病例。各种综合治疗措施的结合都将有助于改善胰腺癌患者的生活质量和延长生存期。
Objective To explore the factors related to the curative resection of pancreatic cancer and to obtain better curative effect. Methods The Chinese Association of Cancer Anticancer Pancreatic Adenocarcinoma retrospectively analyzed 2340 cases of pancreas diagnosed and treated from 1990 to 2000 in 14 major hospitals in 8 provinces and 2 cities. Multivariate survival analysis Cox proportional hazards model was used to identify independent factors that may affect the prognosis of patients with pancreatic cancer. Univariate survival analysis using life table method to calculate the survival curve survival rate, and Gehan score test. Results COX univariate analysis showed that age, occupation, course of disease, tumor location, operation method, postoperative pancreatic fistula, postoperative liver failure, chemotherapy, TNM staging, immunotherapy, hepatic metastasis with or without liver metastasis , Mesenteric vascular invasion and other variables. Cox multivariate analysis showed that patients with age at a = 0.05, surgical methods, postoperative pancreatic fistula, postoperative liver failure, chemotherapy, immunotherapy and other variables, these variables are independent factors that affect the prognosis of pancreatic cancer. Radical surgery relative to non-surgery, and chemotherapy, immunotherapy are protective factors. Of these, 92.91% were over the age of 40 and only 7.09% under the age of 40. The median survival time was 17.11 months in radical surgery of the head of pancreas. The 1-year, 3-year and 5-year survival rates were 54.36%, 13.47% and 8.47%, respectively. Conclusion It is necessary to treat people over the age of 40 as a high risk group and find early cases in time. The combination of various comprehensive therapies will help improve the quality of life and prolong survival in patients with pancreatic cancer.