【作者】 李晓琴；

【导师】 包永星；

【作者基本信息】 新疆医科大学 ， 肿瘤放疗， 2008， 硕士

【摘要】 目的:应用Cox比例风险模型分析晚期胰腺癌预后的因素,并探讨支持治疗、姑息手术和姑息手术联合放射治疗的疗效。方法:2004年3月～2007年2月,我院对109例无法切除的胰腺癌分别行支持治疗55例,胆肠吻合术(姑息手术)26例及姑息手术联合放射治疗28例。将年龄、性别、族别、一般状况、肿瘤分期、肿瘤部位、治疗方式等因素进行单因素分析,将单因素分析有显著性意义的变量引入Cox比例风险模型进行多因素分析。治疗后疼痛缓解程度比较应用χ2检验;放疗前后CA-199水平的比较用t’检验。结果:单因素分析显示,KS评分和治疗方式对预后有统计学意义。Cox比例风险模型显示,仅治疗方式对预后有统计学意义。支持治疗组中治疗前疼痛的49例,治疗后疼痛部分缓解率及完全缓解率分别为32.65%(16/49)及4.08%(2/49);姑息手术组中治疗前疼痛的21例,治疗后疼痛部分缓解率及完全缓解率分别为38.09%(8/21)及4.76%(1/21);姑息手术联合放射治疗组,术前的疼痛的21例,术后疼痛部分缓解率及完全缓解率分别为14.29%(3/21)及76.19%(16/21)。可见姑息手术联合放射治疗组疼痛部分缓解率及完全缓解率显著高于其它两组(P=0.0001)。支持治疗组和姑息手术组中CA-199水平在治疗前后变化无统计学意义,姑息手术联合放射治疗组中治疗后CA-199水平21.2±4.5u/ml,较治疗前231.6±32.9u/ml显著降低,其变化有统计学意义(F=53.4523, P=0.0000)。姑息手术联合放射治疗组的中位生存时间(42.3周)显著长于姑息手术组(17.1周)及支持治疗组(9.5周)(P=0.0000)。结论:治疗方式是影响预后的主要因素。对于不能耐受手术的晚期胰腺癌姑息手术联合放射治疗,在延长生存期的同时可明显缓解患者的疼痛,并降低CA-199水平。更多还原

【Abstract】 Objective: To study the relative factors affecting the prognosis of advanced pancreatic carcinoma with Cox proportional hazard model, and effectiveness of radiotherapy combined with palliative operation. Methods: 109 patients with unresectable and advanced pancreatic carcinoma admitted from Mar.2004 to Feb. 2007 were analyzed with Cox proportional hazard model. 55 cases were treated by the supportive care; 26 cases by palliative operation and 28 cases by palliative operation combined with radiotherapy, respectively. Radiotherapy including iodine125 seed implantation(16 cases) and 3D conformal radiotherapy(12 cases).χ2 test for pain relieving rate pre- and post- radiotherapy; t’test for CA-199 levels before and after the radiotherapy. Results:The major factors affecting prognosis was treatment. Palliative operation combined with radiotherapy could reduce the death risk 7.83 times than other treatments. Among the 21 patients who suffered pain before radiotherapy, complete response was obtained in 76.19%(16/21), partial response in 14.29%(3/21) which is significantly higher than that of other two groups (P=0.0001). The level of CA-199 (21.2±4.5u/ml) after radiotherapy was significantly lower than that of before radiotherapy(231.6±32.9u/ml) (F=53.4523, P=0.0000).The median survival time in combined group was 42.3 weeks, which was significantly longer than that of other two groups (17.1 weeks, 9.5weeks). Conclusion : Palliative operation combined with radiotherapy would improve the prognosis of advanced pancreatic carcinoma. It does show some therapeutic effects for advanced pancreatic carcinoma, in terms of pain relieving rate, CA-199 levels and median survival time.更多还原