目的:探讨十二指肠乳头癌行根治性切除术后5年生存率的影响因素.方法:回顾性分析山东大学齐鲁医院2001年1月-2010年1月收治的68例十二指肠乳头癌行胰十二指肠切除术患者的临床资料,随访截至201 5年1月.Kaplan-Meier法计算生存率,并描绘生存曲线,Log-Rank检验比较生存差异.Cox比例风险模型逐步回归法筛选影响十二指肠乳头癌行PD术患者预后的独立因素.结果:随访时间4～168个月,中位随访时间(57.00±19.93)个月.5年累积生存率为48.5％.单因素分析显示,术前血清总胆红素水平、十二指肠壁浸润程度、淋巴结转移和肿瘤TNM分期参与影响了十二指肠乳头癌行根治术的5年生存率.Cox比例风险模型多因素分析结果显示,十二指肠壁浸润程度和肿瘤TNM分期是影响十二指肠乳头癌行PD术5年生存率的独立影响因素.结论:十二指肠乳头癌行PD根治术后5年生存率与术前血清总胆红素水平、十二指肠壁浸润程度、淋巴结转移和肿瘤TNM分期等多种因素有关;十二指肠壁浸润程度和肿瘤TNM分期是影响十二指肠乳头癌行PD术5年生存率的独立影响因素.%Objective:To evaluate the prognostic factors for duodenalpapilla carcinoma (DPC)treated by pancreatoduodenectomy (PD).Methods:Clinicopathological data of 68 patients with duodenalpapilla carcinoma who undergone PD and finally diagnosed by surgery and histopathology from January 2001 to June 2010 were retrospectively analyzed.The patients were followed-up until 2015.Survival analysis was conducted using the Kaplan-Meier survival and Cox proportional hazards model analysis.The difference in survival curves was evaluated with a log-rank test.Results:The patients were followed-up with a median follow-up of 57 months (ranging from 4 months to 168 months).The univariate analysis showed that increased serum levels of total bilirubin were correlated with a poor prognosis,as well as a senior grade of infiltration depth,lymph node metastases,and TNM stage (P=0.043,0.003,0.004 0.002,respectively).Only increased serum levels of total bilirubin and a senior grade of TNM stage retained their significance when adjustments were made for other known prognostic factors in Cox multivariate analysis (RR=2.031,P=0.031 and RR=2.255,P=0.029).Conclusions:Increased serum levels of total bilirubin were correlated with a poor prognosis,as well as a senior grade of infiltration depth,lymph node metastases,and TNM stage.Only increased serum levels of total bilirubin and a senior grade of TNM stage can serve as independent prognosis indexes in the evaluation of patients with DPC after PD.
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