Background and purpose: Pancreatic carcinoma is a kind of malignant disease with the rising tendency of incidence and poor prognosis. Little progress has been made on the treatment of advanced pancreatic carcinoma during the past 2 decades. The combined mordality for the unresectable pancreatic carcinoma is controversial. We retrospectively reviewed the clinical data and the results of transarterial intervention alone or transarterial intervention combined with radiotherapy, analyzed the prognostic factors for patients with unresectable pancreatic carcinoma. Methods: We retrospective analyzed 105 patients with locally advanced and metastatic pancreatic carcinoma. Univariate and multivariate statistical methods were used to determine significant prognostic factors and therapy program for overall survival (OS). Results: For all patients, the median survival time (MST) was 9.0 months, l-year and 2-year OS were 31.2％ and 12.2％ respectively. For the locally advanced vs phase Ⅳ patients, the MST, l-year, 2-year OS were 9.1 vs 7.6 months, 33.2％ vs 29.3％ and 14.7％ vs 9.1％ respectively. On univariate analysis, the number of interventional therapy, whether combined with radiotherapy or not, the choice of gemcitabine programs and primary tumor site were important factors for OS. For all 105 patients, the MST of patients who received multiple transarterial therapy was 4.9 months longer than those who had single therapy (12.5 vs 7.6 monthes, P=0.010). l-year and 2-year OS were 51.5％ vs 22.2％ and 20.7％ vs 8.1％. The MST of patients who received combined therapy was 4.3 months longer compared with who had only interventional therapy ( 11.9 vs 7.6 monthes, P=0.003), l-year, 2-year OS were 48.5％ vs 21.8％ and 27.7％ vs 2.7％. The MST of patients who received gemcitabine programs was 2.2 months longer compared with who had other programs (9.8 vs 7.6 monthes, P=0.018), 1-year, 2-year OS were 37.5％ vs 18.8％ and 20.3％ vs 3.1％. The MST of patients with pancreatic head cancer was 3.0 months longer compared with the patients whose cancer located in pancreatic body or tail (10.5 vs 7.5 monthes, P=0.031), 1-year, 2-year OS were 40.2％ vs 22.0％ and 6.3％ vs 8.8％. On multivariate analysis, Interventional therapy combined radiotherapy was independent prognostic factor for OS, it could decrease death risk for all patients 46％ (95％CI: 0.272-0.891, P=0.047). Conclusion: In the current study, transarterial intervention combined with radiotherapy can improve overall survival among patients with unresectable pancreatic cancer.%背景与目的:胰腺癌发病率逐年提高,预后差,近20年间治疗进展缓慢.不能手术切除的胰腺癌尚无明确的综介治疗模式.本文通过对不能手术切除的胰腺癌患者的回顾性分析,探讨介入化疗及介入化疗联合三维适形放疗(three-dimensional conformal radiation therapy,3DCRT)的疗效和影响胰腺癌预后的重要因素.方法:回顾性分析105例局部晚期和伴远处转移的胰腺癌患者,并对影响胰腺癌预后的因素和治疗模式进行单因素及Cox多因素分析.结果:全组中位生存时间(median survival time,MST)为9.0个月,1年总生存率(overall survival,OS)为31.2%,2年OS为12.2%.局部晚期胰腺癌MST为9.1个月,1年和2年OS分别为33.2%和14.7%.Ⅳ期胰腺痛MST为7.6个月,1年和2年OS分别为29.3%和9.1%.影响全组胰腺癌生存的单因素有:介入治疗次数、是否联合放疗、是否选用吉西他滨方案及肿瘤原发部位.在全组105例胰腺癌中,多次介入者的MST较单次介入者长4.9个月(12.5 vs 7.6个月,P=0.010),1年和2年OS分别为51.5%、22.2%和20.7%、8.1%.联合放疗者的MST较单纯介入治疗者长4.3个月(11.9 vs 7.6个月,P=0.003),1年和2年OS分别为48.5%、21.8%和27.7%、2.7%;吉西他滨方案的MST较其他方案者长2.2个月(9.8vs7.6个月,P=0.018),1年和2年OS分别为37.5%、18.8%和20.3%、3.1%.胰头癌的MST较体尾部者长3.0个月(10.5 vs 7.5个月,P=0.031),1年和2年OS分别为40.2%、22.0%和6.3%、8.8%.多因素分析显示,介入联合放疗可以使全组胰腺癌死亡风险下降46%(95%CI=0.272～0.891,P=0.047).结论:对于不能手术的局部晚期及Ⅳ期胰腺癌,放疗联合介入治疗给患者带来生存获益.
展开▼
