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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 ›› 2025, Vol. 15 ›› Issue (01) : 73 -78. doi: 10.3877/cma.j.issn.2095-3232.2026.01.012

临床研究

胰腺癌肝转移临床特征及危险因素
宋辉1, 朱亮2, 于茜1,†()   
  1. 1　266400　青岛大学附属医院西海岸院区肿瘤免疫和细胞治疗中心
    2　100730　北京协和医院放射科
  • 收稿日期:2025-07-08 出版日期:2025-02-10
  • 通信作者: 于茜
  • 基金资助:
    山东省自然科学基金(ZR2022QH241)

Clinical characteristics and risk factors of liver metastasis from pancreatic cancer

Hui Song1, Liang Zhu2, Qian Yu1,†()   

  1. 1 Center for Tumor Immunity and Cell Therapy, the Affiliated Hospital of Qingdao University (West Coast Campus), Qingdao 266400, China
    2 Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China
  • Received:2025-07-08 Published:2025-02-10
  • Corresponding author: Qian Yu
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引用本文：

宋辉, 朱亮, 于茜. 胰腺癌肝转移临床特征及危险因素[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 15(01): 73-78.

Hui Song, Liang Zhu, Qian Yu. Clinical characteristics and risk factors of liver metastasis from pancreatic cancer[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 15(01): 73-78.

目的

探讨胰腺癌肝转移的发病特点及相关危险因素，为该人群的预防、筛查和治疗提供科学依据。

方法

回顾性分析2013年1月至2023年12月北京协和医院收治的593例胰腺癌患者临床资料。其中男275例，女318例；年龄25~85岁，中位年龄62岁。将患者分为肝转移组（157例）和对照组（436例）。总结胰腺癌肝转移的临床特点，采用Logistic多因素回归分析胰腺癌肝转移的影响因素，纳入协变量包括性别、年龄、吸烟、饮酒、糖尿病、手术、代谢相关性脂肪性肝病（MAFLD）、WBC、中性粒细胞、淋巴细胞、ALT、AST、TB、DB、GGT、ALP、Scr、ALB、CA19-9、CEA等。

结果

胰腺癌肝转移发生率26.5%（157/593）。胰腺癌肝转移吸烟患者占比、合并MAFLD明显升高，而手术占比偏低（χ2=5.18，108.04，40.50；P<0.05）；ALT、ALT/AST、GGT、ALP、CA19-9明显升高，血尿素氮明显偏低（Z=2.97，3.21，3.48，2.35，3.43，2.78；P<0.05）。Logistic多因素分析显示，吸烟（OR=1.703，95%CI：1.046~2.771）和MAFLD（OR=9.153，95%：5.732~14.617）是胰腺癌患者发生肝转移的独立危险因素（P<0.05）；手术是胰腺癌患者发生肝转移的重要保护因素（OR=0.260，95%CI：0.166~0.407，P<0.05）。

结论

胰腺癌肝转移发生率较高，MAFLD和吸烟是胰腺癌肝转移的独立危险因素，而手术是胰腺癌肝转移的保护因素。对于确诊可切除的胰腺癌患者建议手术切除病灶，将戒烟纳入胰腺癌患者的全程管理。对合并MAFLD的胰腺癌高危人群进行筛查，同时加强对MAFLD和吸烟风险知识的健康宣教。

关键词: 胰腺癌, 肝转移, 危险因素, 预防措施, 代谢相关性脂肪性肝病
Objective

To investigate clinical characteristics and risk factors of liver metastasis from pancreatic cancer, aiming to provide scientific evidence for prevention, screening and treatment of this population.

Methods

Clinical data of 593 patients with pancreatic cancer admitted to Peking Union Medical College Hospital from January 2013 to December 2023 were retrospectively analyzed. Among them, 275 patients were male and 318 female, aged from 25 to 85 years, with a median age of 62 years. All patients were divided into the liver metastasis group (n=157) and control group (n=436). Clinical characteristics of liver metastasis from pancreatic cancer were summarized. The influencing factors of liver metastasis from pancreatic cancer were assessed by multivariate Logistic regression analysis. Multiple covariates consisting of gender, age, smoking, drinking, diabetes mellitus, surgery, metabolism-associated fatty liver disease (MAFLD), WBC, neutrophils, lymphocytes, ALT, AST, TB, DB, GGT, ALP, Scr, ALB, CA19-9 and CEA were included.

Results

The incidence of liver metastasis from pancreatic cancer was 26.5%(157/593). The proportion of patients with liver metastasis from pancreatic cancer who smoked and were complicated with MAFLD was increased significantly, while the proportion of patients undergoing surgery was relatively low (χ2= 5.18,108.04,40.50; all P<0.05). ALT, ALT/AST, GGT, ALP and CA19-9 levels were significantly increased, and blood urea nitrogen level was significantly decreased (Z=2.97, 3.21, 3.48, 2.35, 3.43, 2.78; all P<0.05). Multivariate Logistic analysis showed that smoking (OR=1.703, 95%CI: 1.046-2.771) and MAFLD (OR=9.153, 95%CI: 5.732-14.617) were the independent risk factors for liver metastasis in patients with pancreatic cancer (both P<0.05). Surgery is an important protective factor for pancreatic cancer patients with liver metastasis (OR=0.260, 95%CI: 0.166-0.407, P<0.05).

Conclusions

The incidence of liver metastasis from pancreatic cancer is relatively high. MAFLD and smoking are the independent risk factors, whereas surgery is a protective factor for for liver metastasis from pancreatic cancer. Surgical resection is recommended for patients with resectable pancreatic cancer. Smoking cessation should be included in the whole management of pancreatic cancer patients. Extensive attention should be diverted to the screening of pancreatic cancer patients with high-risk MAFLD. Health education on MAFLD and smoking risk knowledge should be strengthened.

Key words: Pancreatic cancer, Liver metastasis, Risk factors, Preventive measures, Metabolic associated fatty liver disease
表1 两组胰腺癌患者临床资料比较
指标 肝转移组 对照组 统计值 P值
性别(例, 男/女) 80/77 195/241 χ2=1.80 0.179
年龄[岁, M(Q1, Q3)] 62(55, 68) 63(56, 68) Z=-0.48 0.631
WBC[×109/L, M(Q1, Q3)] 6.0 (5.1, 7.2) 5.8 (4.9, 7.1) Z=1.43 0.153
中性粒细胞[×109/L, M(Q1, Q3)] 4.0(3.1, 4.9) 3.7(2.9, 4.6) Z=1.77 0.076
淋巴细胞[×109/L, M(Q1, Q3)] 1.5(1.1, 1.9) 1.5(1.1, 1.9) Z=0.80 0.421
血尿酸[μmol/L, M(Q1, Q3)] 267 (211, 319) 266 (217, 325) Z=0.79 0.429
血尿素氮[g/L, M(Q1, Q3)] 4.4 (3.6, 5.2) 4.7 (3.9, 5.7) Z=-2.78 0.005
Scr[μmol/L, M(Q1, Q3)] 62(52, 72) 62(54, 73) Z=-0.86 0.389
ALB[g/L, M(Q1, Q3)] 43(41, 45) 43(40, 45) Z=0.63 0.531
ALT[U/L, M(Q1, Q3)] 30(18, 243) 22(14, 140) Z=2.97 0.003
AST[U/L, M(Q1, Q3)] 25(18, 144) 23(18, 81) Z=1.65 0.099
ALT/AST[M(Q1, Q3)] 1.2(0.8, 1.6) 1.0(0.7, 1.3) Z=3.21 0.001
TB[μmol/L, M(Q1, Q3)] 16.8(10.8, 113.6) 14.8(10.2, 68.0) Z=1.72 0.086
DB[μmol/L, M(Q1, Q3)] 5.2(3.6, 84.6) 5.0(3.3, 50.6) Z=1.66 0.097
GGT[U/L, M(Q1, Q3)] 68(25, 627) 32(18, 319) Z=3.48 <0.001
LDH[IU/L, M(Q1, Q3)] 188(163, 248) 186(162, 215) Z=1.87 0.062
ALP[IU/L, M(Q1, Q3)] 113(81, 296) 94(714, 291) Z=2.35 0.019
CA19-9[kU/L, M(Q1, Q3)] 309(89, 745) 142(49, 439) Z=3.43 <0.001
CEA[mg/L, M(Q1, Q3)] 3.5(2.3, 5.9) 3.2 (2.0, 5.0) Z=1.90 0.057
糖尿病(例) 40 116 χ2=0.08 0.783
吸烟(例) 46 89 χ2=5.18 0.023
手术(例) 69 315 χ2=40.50 <0.001
MAFLD(例) 89 63 χ2=108.04 <0.001
表2 胰腺癌肝转移影响因素Logistic多因素回归分析
因素 b SE(b) Wald χ2 OR 95% CI P值
吸烟 0.532 0.249 4.584 1.703 1.046~2.771 0.032
手术 -1.348 0.229 34.598 0.260 0.166~0.407 <0.001
MAFLD 2.214 0.239 85.951 9.153 5.732~14.617 <0.001
ALT 0.001 0.001 2.108 1.001 1.000~1.003 0.146
TB -0.002 0.001 2.304 0.998 0.995~1.001 0.129
LDH -0.000 0.002 0.001 1.000 0.996~1.004 0.978
血尿素氮 -0.108 0.078 1.938 0.897 0.770~1.045 0.164
CA19-9 0.000 0.000 1.809 1.000 1.000~1.000 0.179
CEA 0.014 0.007 3.748 1.014 1.000~1.029 0.053
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