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胰腺癌精确放疗的疗效及预后因素

胡克 侯晓荣 张福泉 杨波 戴梦华 赵林

胡克, 侯晓荣, 张福泉, 杨波, 戴梦华, 赵林. 胰腺癌精确放疗的疗效及预后因素[J]. 协和医学杂志, 2013, 4(4): 371-376. doi: 10.3969/j.issn.1674-9081.2013.04.006
引用本文: 胡克, 侯晓荣, 张福泉, 杨波, 戴梦华, 赵林. 胰腺癌精确放疗的疗效及预后因素[J]. 协和医学杂志, 2013, 4(4): 371-376. doi: 10.3969/j.issn.1674-9081.2013.04.006
Ke HU, Xiao-rong HOU, Fu-quan ZHANG, Bo YANG, Meng-hua DAI, Lin ZHAO. Effectiveness and Prognostic Factors of Precise Radiotherapy for Pancreatic Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(4): 371-376. doi: 10.3969/j.issn.1674-9081.2013.04.006
Citation: Ke HU, Xiao-rong HOU, Fu-quan ZHANG, Bo YANG, Meng-hua DAI, Lin ZHAO. Effectiveness and Prognostic Factors of Precise Radiotherapy for Pancreatic Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(4): 371-376. doi: 10.3969/j.issn.1674-9081.2013.04.006

胰腺癌精确放疗的疗效及预后因素

doi: 10.3969/j.issn.1674-9081.2013.04.006
详细信息
    通讯作者:

    胡克 电话:010-69155483, E-mail:huke8000@163.com

  • 中图分类号: R735.9

Effectiveness and Prognostic Factors of Precise Radiotherapy for Pancreatic Cancer

More Information
  • 摘要:   目的  分析胰腺癌的精确放疗疗效及预后因素。  方法  2003年1月至2012年6月间接受精确放疗的胰腺癌患者102例, 其中根治性放疗54例, 辅助性放疗48例; 三维适形放疗平均16例, 调强放疗86例; 中位放疗剂量50 Gy, 1.8~2.2 Gy/次。13例同步卡培他滨化疗。  结果  所有患者总生存时间(overall survival, OS)为(14±1.2)个月, 无进展生存时间(progress-free survival, PFS)为(9±1.1)个月。1、2、5年生存率分别为63.3%、22.6%、10%。毒性反应包括3级消化道毒性5例, 未发生3、4级血液学和4级消化道毒性反应。单因素分析结果表明, 治疗前体重下降 > 5 kg(P < 0.0001)、T分期(P=0.011)、TNM分期(P=0.007)、是否行肿瘤切除术(P=0.001)是影响OS的预后因素, 同时也是PFS的预后因素。多因素分析结果表明, 肿瘤切除术是OS的预后因素(χ2=5.416, P=0.020)。  结论  在胰腺癌的根治性放疗和辅助性放疗中, 三维适形放疗和调强放疗都可以较好地耐受, 3、4级毒性反应较少, 为放化疗同步及肿瘤放疗剂量的提升提供了可行性; 手术切除提高了OS。
  • 图  1  胰腺癌放疗患者总生存曲线

    图  2  胰腺癌放疗患者无进展生存曲线

    图  3  手术与否与总生存时间(A)及无进展生存时间(B)的单因素分析结果

    图  4  肿瘤分期与总生存时间(A)及无进展生存时间(B)的单因素分析结果

    表  1  胰腺癌放疗患者基本临床资料

    临床资料 例(%)
    性别 60(58.8%)
    42(41.2%)
    年龄(岁) ≤60 42(41.2%)
    >60 60(58.8%)
    腹痛 69(67.6%)
    33(32.4%)
    黄疸 23(22.5%)
    79(77.5%)
    体重减轻(kg) ≤5 59(57.8%)
    >5 43(42.2%)
    肿瘤部位 胰头 50(49.0%)
    胰体 52(51.0%)
    T分期 T1 1(1.0%)
    T2 4(3.9%)
    T3 46(45.1%)
    T4 51(50.0%)
    N分期 N0 69(67.6%)
    N1 33(32.4%)
    TNM分期 ⅠB 4(3.9%)
    ⅡA 27(26.5%)
    ⅡB 27(26.5%)
    44(43.1%)
    手术 48(47.1%)
    54(52.9%)
    化疗 52(51.0%)
    50(49.0%)
    放疗剂量(Gy) ≤45 13(12.7%)
    45~55 48(47.1%)
    >55 41(40.2%)
    下载: 导出CSV

    表  2  影响总生存时间及无进展生存时间的单因素分析

    因素 总生存时间 无进展生存时间
    月(x±s) χ2 P 月(x±s) χ2 P
    性别 14±1.6 0.696 0.404 9±1.7 0.245 0.621
    15±2.2 9±1.5
    年龄(岁) ≤61 15±1.2 1.445 0.229 10±1.9 1.342 0.247
    >61 14±1.8 9±1.2
    体重下降(kg) ≤5 18±3.9 14.500 <0.0001 11±1.9 14.606 <0.0001
    >5 11±2.2 6±0.8
    肿瘤部位 胰头 16±0.9 0.333 0.564 10±1.4 0.310 0.577
    胰体 12±1.7 7±1.2
    T分期 T1 6 11.180 0.011 3 15.717 0.001
    T2 17±0.8 5±0.0
    T3 17±2.0 11±1.7
    T4 11±1.0 7±0.7
    N分期 N0 15±1.3 3.334 0.068 10±1.1 2.807 0.094
    N1 12±2.5 7±0.9
    TNM分期 ⅠB 17±0.0 12.073 0.007 5±0.0 12.989 0.005
    ⅡA 23±8.8 19±7.9
    ⅡB 11±3.8 7±1.3
    12±1.1 7±0.8
    手术 22±3.2 11.885 0.001 11±2.1 10.250 0.001
    11±1.3 7±0.6
    放疗剂量(Gy) ≤45 13±3.9 0.133 0.936 7±0.8 0.158 0.924
    45~55 14±1.6 10±2.3
    >55 15±1.9 8±1.2
    CA19-9(kU/L) ≤200 16±2.2 2.779 0.096 10±0.8 1.288 0.256
    >200 13±1.7 7±0.8
    下载: 导出CSV

    表  3  影响总生存时间及无进展生存时间的多因素分析

    因素 总生存时间 无进展生存时间
    Wald值 P Wald值 P
    性别(男,女) 0.215 0.643 0.047 0.829
    年龄(≤61岁,>61岁) 0.062 0.804 0.177 0.674
    体重下降(≤5 kg,>5 kg) 1.839 0.175 3.541 0.060
    肿瘤部位(胰头,胰体) 0.784 0.376 0.811 0.368
    T分期(1,2,3,4) 0.457 0.499 1.359 0.244
    N分期(0,1) 3.675 0.055 0.833 0.361
    TNM分期(ⅠB, ⅡA, ⅡB, Ⅲ) 1.435 0.231 2.599 0.107
    手术(有,无) 5.416 0.020 2.799 0.094
    放疗剂量(45 Gy,45~55 Gy,
    55 Gy)
    1.010 0.315 0.536 0.464
    CA19-9(≤200 kU/L,>200 kU/L) 0.730 0.393 1.348 0.246
    下载: 导出CSV
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  • 收稿日期:  2013-08-30
  • 刊出日期:  2013-10-30

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