Perioperative factors associated with prognosis of patients after radical resection of pancreatic cancer: a retrospective analysis

朱序勤; 贾淞淋; 祁　洁; 申雪芳; 龙　江; 缪长虹

doi:10.19401/j.cnki.1007-3639.2019.07.007

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Perioperative factors associated with prognosis of patients after radical resection of pancreatic cancer: a retrospective analysis

更新时间：2026-01-27

- Perioperative factors associated with prognosis of patients after radical resection of pancreatic cancer: a retrospective analysis
- China Oncology Vol. 29, Issue 7, Pages: 521-527(2019)
- 作者机构：
  
  1. 复旦大学附属肿瘤医院麻醉科，复旦大学上海医学院肿瘤学系,上海,200032
  2. 复旦大学附属肿瘤医院胰腺外科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2019.07.007
  CLC： R735.9
- Published Online：12 July 2019，
  
  Published：12 July 2019
- 稿件说明：
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朱序勤,贾淞淋,祁　洁,申雪芳,龙　江,缪长虹 . 影响胰腺癌根治术预后的围手术期相关因素的回顾性分析[J]. 中国癌症杂志, 2019, 29(7): 521-527.

朱序勤, 贾淞淋, 祁　洁, et al. Perioperative factors associated with prognosis of patients after radical resection of pancreatic cancer: a retrospective analysis[J]. China Oncology, 2019, 29(7): 521-527.
朱序勤,贾淞淋,祁　洁,申雪芳,龙　江,缪长虹 . 影响胰腺癌根治术预后的围手术期相关因素的回顾性分析[J]. 中国癌症杂志, 2019, 29(7): 521-527. DOI： 10.19401/j.cnki.1007-3639.2019.07.007.

朱序勤, 贾淞淋, 祁　洁, et al. Perioperative factors associated with prognosis of patients after radical resection of pancreatic cancer: a retrospective analysis[J]. China Oncology, 2019, 29(7): 521-527. DOI： 10.19401/j.cnki.1007-3639.2019.07.007.

摘要

背景与目的：胰腺癌是恶性程度极高的肿瘤，即使接受根治性切除手术，其预后也较差。为了更好地了解围手术期麻醉管理策略在改善患者预后中的作用，回顾性分析胰腺癌手术的相关资料以判明这些因素与预后的关系。方法：回顾性分析2011年12月—2016年1月在复旦大学附属肿瘤医院行胰腺癌根治性切除术的190例患者的围手术期临床和病理学资料，随访截至2019年1月。采用COX比例风险模型进行单因素和多因素分析。结果：COX比例风险模型单因素分析显示，术前CA19-9和中性粒细胞/淋巴细胞比值（neutrophil-lymphocyte ratio，NLR）、TNM分期、肿瘤分化程度和最大直径、淋巴结转移、术中失血量和输血与总生存期（overall survival，OS）均有显著相关性；术中应用地塞米松与OS之间也有一定的相关性（P=0.052，HR=0.73）。多因素回归分析显示，肿瘤分化程度（P=0.001，HR=0.59）、肿瘤最大直径（P=0.039，HR=1.51）、淋巴结转移（P=0.003，HR=1.61）、术中输血（P=0.046，HR=1.39）与OS都有显著相关性。术中输血组的中位生存期（15.7个月）比未输血组（23.3个月）明显缩短。结论：围手术期麻醉管理策略对保护患者免疫功能、降低复发转移风险、改善预后很重要。合理选择麻醉方式和麻醉药物，优化麻醉管理策略，建立个体化的输血管理方案，对于改善胰腺癌手术患者的远期生存具有重要意义。

Abstract

Background and purpose: Pancreatic cancer is a devastating disease. Even after radical resection of pancreatic cancer

the prognosis still remains poor. To better understand the effects of perioperative anesthesia strategy on improving long-term survival

this retrospective analysis investigated associations between perioperative factors and survival in patients undergoing pancreatic cancer surgery. Methods: Survival data ［overall survival (OS)］ and perioperative clinicopathological parameters for 190 patients who underwent radical resection of pancreatic cancer between December 2011 and January 2016 were obtained in Fudan University Shanghai Cancer Center. The last follow-up time was January 2019. The authors performed univariate and multivariate analyses using the COX proportional hazards regression model. Results: Univariate analyses revealed that preoperative CA19-9 level and neutrophil-lymphocyte ratio (NLR)

TNM stage

differentiation

maximum size of tumor

lymph node metastasis

intraoperative blood loss and transfusion were significantly associated with OS in patients with radical resection of pancreatic cancer. Dexamethasone also showed a little association with OS (P=0.052

HR=0.73). Differentiation (P=0.001

HR=0.59)

maximum size of tumor (P=0.039

HR=1.51)

lymph node metastasis (P=0.003

HR=1.61) and intraoperative transfusion (P=0.046

HR=1.39) were identified as significant associations with OS by multivariate analyses. The median survival time (15.7 months vs 23.3 months) of transfused patients was shorter than that of transfusion-free patients. Conclusion: Perioperative anesthesia strategy is very important to protect immune functions and reduce risks of recurrence and metastasis in pancreatic cancer patients. It is necessary for us to choose reasonable anesthetic techniques and agents

optimize anesthesia management and establish an individual transfusion scheme in order to improve long-term survival.

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