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目的探讨螺旋断层调强放射治疗局部晚期胰腺癌(locally advanced pancreatic cancer,LAPC)的疗效和预后影响因素。方法回顾本院放疗科2012年1月-2015年12月20例无法手术且接受螺旋断层调强放射治疗的LAPC患者的临床资料,进行近期疗效和长期生存观察,并通过Log-rank法和Cox回归模型分别进行单因素和多因素分析,判断影响预后的因素。结果本研究纳入20例局部晚期胰腺癌患者,男13例,女7例;中位年龄56岁;13例肿瘤位于胰头(62.5%),7例位于胰体/尾(37.5%)。7例放疗后CA199水平下降;8例疼痛缓解(8/11)。放疗后1年、2年生存率分别为40%(8/20)、10%(2/20)。采用Cox回归模型进行多因素分析显示,肿瘤部位和卡氏评分(Karnofsky performance status,KPS)是影响螺旋断层放疗后胰腺癌预后的独立因素。1例放疗后发生Ⅲ级血液系统反应,未见Ⅲ级及以上消化道反应。结论螺旋断层放射治疗是一种治疗LAPC的有效方式,肿瘤部位和KPS评分是影响预后的独立因素。
Objective To investigate the efficacy and prognostic factors of locally advanced pancreatic cancer (LAPC) treated with intensity-modulated spiral tomography. Methods The clinical data of 20 patients with LAPC who underwent unresectable surgery and IMRT for January 2012 to December 2015 in our hospital were retrospectively reviewed. The short-term efficacy and long-term survival were observed. Log-rank method and Cox Regression model were univariate and multivariate analysis to determine the factors that affect the prognosis. Results The study included 20 patients with locally advanced pancreatic cancer, 13 males and 7 females; the median age was 56 years. Thirteen tumors were located in the head of the pancreas (62.5%) and 7 were located in the pancreatic body / caudate tail (37.5%). The level of CA199 was decreased in 7 cases after radiotherapy and the pain was relieved in 8 cases (8/11). One year after radiotherapy, the 2-year survival rates were 40% (8/20) and 10% (2/20), respectively. Multivariate analysis using Cox regression model showed that tumor location and Karnofsky performance status (KPS) were independent prognostic factors of pancreatic cancer after helical CT. One patient had grade Ⅲ hematologic reaction after radiotherapy, and no grade Ⅲ or above gastrointestinal reaction was found. Conclusion Spiral tomography is an effective way to treat LAPC. Tumor site and KPS scores are independent prognostic factors.