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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (05) : 484 -488. doi: 10.3877/cma.j.issn.2095-3232.2021.05.011

临床研究

辅助化疗在预防胰腺导管腺癌术后早期复发中的应用价值
朱磊1, 顾洪柱1, 李珊珊2, 李雨成3,†()   
  1. 1. 124010　辽宁省盘锦辽油宝石花医院普通外科
    2. 124010　辽宁省盘锦辽油宝石花医院药学部
    3. 124010　辽宁省盘锦辽油宝石花医院外科教研室
  • 收稿日期:2021-06-03 出版日期:2021-08-17
  • 通信作者: 李雨成

Application value of adjuvant chemotherapy in preventing early recurrence of pancreatic ductal adenocarcinoma after surgery

Lei Zhu1, Hongzhu Gu1, Shanshan Li2, Yucheng Li3,†()   

  1. 1. Department of General Surgery, Panjin Liaoyou Baoshihua Hospital, Panjin 124010, China
    2. Department of Pharmacy, Panjin Liaoyou Baoshihua Hospital, Panjin 124010, China
    3. Teaching and Research Office of Surgery, Panjin Liaoyou Baoshihua Hospital, Panjin 124010, China
  • Received:2021-06-03 Published:2021-08-17
  • Corresponding author: Yucheng Li
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朱磊, 顾洪柱, 李珊珊, 李雨成. 辅助化疗在预防胰腺导管腺癌术后早期复发中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 484-488.

Lei Zhu, Hongzhu Gu, Shanshan Li, Yucheng Li. Application value of adjuvant chemotherapy in preventing early recurrence of pancreatic ductal adenocarcinoma after surgery[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(05): 484-488.

目的

探讨辅助化疗在预防胰腺导管腺癌（PDAC）术后早期复发中的应用价值。

方法

回顾性分析2011年1月至2014年12月在盘锦辽油宝石花医院收治的132例PDAC患者临床资料。其中男79例，女53例；年龄42~81岁，中位年龄66岁。患者均签署知情同意书，符合医学伦理学规定。根据术后早期6个月内有无复发，将患者分为早期复发组和非早期复发组。根据治疗方式不同将患者分为单纯手术组、术前化疗组、术后化疗组、术前+术后化疗组。早期复发相关因素及不同治疗模式对复发的影响分析采用χ2检验。

结果

58例接受术前新辅助化疗，98例接受术后辅助化疗。早期复发39例，其中局部复发17例，远处转移22例。影响因素分析显示，TNM分期、术前CA19-9水平、术前新辅助化疗、肿瘤大小、术后并发症、术后辅助化疗与术后早期复发相关（χ2=6.752，5.088，5.563，4.404，4.320，4.672；P<0.05）。术前+术后化疗组早期局部复发率明显低于单纯手术组（χ2=5.834，P<0.016）。术后化疗组和术前+术后化疗组早期远处转移发生率明显低于单纯手术组（χ2=8.532，8.210；P<0.017），亦明显低于术前化疗组（χ2=6.842，6.729；P<0.017）。

结论

PDAC术后早期复发与肿瘤TNM分期、CA19-9水平及辅助化疗有关，术前新辅助化疗联合术后辅助化疗可预防PDAC术后早期局部复发和远处转移。

关键词: 胰腺肿瘤, 复发, 化学治疗
Objective

To investigate the application value of adjuvant chemotherapy in preventing early recurrence of pancreatic ductal adenocarcinoma (PDAC) after surgery.

Methods

Clinical data of 132 PDAC patients admitted to Panjin Liaoyou Baoshihua Hospital from January 2011 to December 2014 were retrospectively analyzed. Among them, 79 patients were male and 53 female, aged from 42 to 81 years, with a median age of 66 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into early recurrence group and non-early recurrence group according to whether PDAC recurred within 6 months after surgery. All patients were divided into the single surgery, preoperative chemotherapy, postoperative chemotherapy, pre- and postoperative chemotherapy groups according to different treatment methods. The impact factors related to early recurrence, and the impact of different treatment patterns on the recurrence were analyzed by Chi-square test.

Results

58 patients received preoperative neoadjuvant chemotherapy and 98 cases received postoperative adjuvant chemotherapy. Early recurrence occurred in 39 cases, including 17 cases of local recurrence and 22 cases of distant metastasis. The analysis result showed that TNM stage, preoperative CA19-9 level, preoperative neoadjuvant chemotherapy, tumor size, postoperative complications and postoperative adjuvant chemotherapy were significantly correlated with early postoperative recurrence (χ2=6.752, 5.088, 5.563, 4.404, 4.320, 4.672; P<0.05). The early local recurrence rate in the pre- and postoperative chemotherapy group was significantly lower than that in the single surgery group (χ2=5.834, P=0.016). The early distant metastasis rates in the postoperative chemotherapy group, pre- and postoperative chemotherapy group were significantly lower than those in single surgery group (χ2=8.532, 8.210; P<0.017), and significantly lower compared with that in the preoperative chemotherapy group (χ2=6.842, 6.729; P<0.017).

Conclusions

Early postoperative recurrence of PDAC is associated with tumor TNM stage, CA19-9 level and adjuvant chemotherapy. Preoperative neoadjuvant chemotherapy combined with postoperative adjuvant chemotherapy can prevent the early postoperative local recurrence and distant metastasis of PDAC.

Key words: Pancreatic neoplasms, Recurrence, Chemotherapy
表1 胰腺导管腺癌术后早期复发相关因素分析（例）
因素 早期复发组 非早期复发组 χ2值 P值
TNM分期     6.752 0.034
  Ⅰ期 5 21    
  Ⅱ期 15 48    
  Ⅲ期 19 24    
术前CA19-9 （kU/L）     5.088 0.024
  ≤37 13 51    
  >37 26 42    
术前新辅助化疗     5.563 0.018
  无 28 46    
  有 11 47    
肿瘤大小（cm）     4.404 0.036
  ≤3 14 52    
  >3 25 41    
术后并发症     4.320 0.038
  无 18 61    
  有 21 32    
术后辅助化疗     4.672 0.031
  无 15 19    
  有 24 74    
表2 不同治疗方案胰腺导管腺癌患者术后早期复发部位分析（例）
组别 例数 早期局部复发 早期远处转移
单纯手术组 21 6 8
术前化疗组 13 0 5
术后化疗组 53 8 5a,b
术前+术后化疗组 45 3a 4a,b
χ2值   8.310 15.345
P值   0.040 0.002
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