十二指肠腺癌88例临床特征及相关预后因素

耿证琴; 谢琳; 宋红莉; 李蓉; 廖冶丹; 张雪琪; 唐嘉黛

doi:10.12259/j.issn.2095-610X.S20220109

十二指肠腺癌88例临床特征及相关预后因素

doi: 10.12259/j.issn.2095-610X.S20220109

耿证琴^{1, 2},
谢琳^1, ,,
宋红莉¹,
李蓉¹,
廖冶丹¹,
张雪琪¹,
唐嘉黛¹

1.
云南省肿瘤医院/昆明医科大学第三附属医院消化肿瘤内科，云南昆明　650118
2.
曲靖市妇幼保健院妇二科，云南曲靖　655000

基金项目: 国家自然科学基金资助项目（81760520）；云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目（202001AY070001-073）

详细信息

作者简介:
耿证琴（1993～），女，云南昆明人，医学硕士，住院医师，主要从事肿瘤综合治疗工作

通讯作者:
谢琳，E-mail：xielinyanghan@163.com

中图分类号: R735.3⁺1
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出版历程
- 收稿日期: 2021-12-08
- 网络出版日期: 2021-12-20
- 刊出日期: 2022-01-15

Clinical Features and Related Prognostic Factors of 88 Cases of Duodenal Adenocarcinoma

1.
Dept.of Gastrointestinal Oncology，Yunnan Cancer Hospital/The Third Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650118
2.
Dept. of Gynecology，Qujing Maternal and Child Health Hospital，Qujing Yunnan 655000，China

摘要

摘要: 目的分析十二指肠腺癌患者的临床特征及相关预后因素。方法对云南省肿瘤医院2010年1月至2019年12月期间收治的经病理确诊的88例十二指肠腺癌患者进行回顾性研究。采用Kaplan-Meier法评估患者的生存状况，用Log-rank检验进行单因素分析，Cox比例风险回归模型进行多因素分析，从而筛选出影响十二指肠腺癌患者预后的相关危险因素。结果 88例十二指肠腺癌患者的年龄范围：23～79岁，平均年龄为54.83岁，男女比例：1.44∶1。生存分析提示：十二指肠腺癌患者发生转移、无转移的中位生存时间分别为14个月、19个月，即发生转移较无转移者预后更差（P < 0.05）。单因素分析显示：转移有无、原发灶直径、临床分期、化疗方案、化疗药物种类、手术方式、Hp感染、CEA、CA199、AST/ALT、NKC、PLT、LMR与十二指肠腺癌患者预后有关（P < 0.05）。Cox多因素分析提示：发生转移、Hp（+）、CA199 > 27 U/mL是影响十二指肠腺癌患者预后的独立危险因素（P < 0.05），而根治性手术是十二指肠腺癌患者预后的有益因素（P < 0.05）。结论十二指肠腺癌发生转移则预后极差，需早期密切监测，临床上可用有无转移、手术方式、Hp感染、CA199 4个指标预测患者预后。
- 十二指肠腺癌 /
- 临床特征 /
- 预后
Abstract: Objective To analyze the clinical characteristics and related prognostic factors of patients with duodenal adenocarcinoma. Methods 88 patients with duodenal adenocarcinoma who were pathologically diagnosed and admitted to Yunnan Cancer Hospital from January 2010 to December 2019 were studied retrospectively. The Kaplan-Meier method was used to evaluate the survival status of patients, the Log-rank test was used for univariate analysis, and the Cox proportional hazard regression model was used for multivariate analysis to screen out the relevant risk factors affecting the prognosis of patients with duodenal adenocarcinoma. Results The age range of 88 patients with duodenal adenocarcinoma: 23-79 years old, with an average age of 54.83 years old, male to female ratio: 1.44∶1. Survival analysis showed that the median survival time of patients with and without metastasis of duodenal adenocarcinoma was 14 months and 19 months respectively, the prognosis of patients with metastasis was worse than those without metastasis （P < 0.05）. Univariate analysis showed that the presence or absence of metastasis, primary tumor diameter, clinical stage, chemotherapy regimens, types of chemotherapy drugs, surgical methods, Hp infection, CEA, CA199, AST/ALT, NKC, PLT, LMR were related to the prognosis of duodenal adenocarcinoma patients （P < 0.05）. Cox multivariate analysis suggested that metastasis, Hp （+）, CA199 > 27 U/mL were the independent risk factors affecting the prognosis of patients with duodenal adenocarcinoma （P < 0.05）, and radical surgery was the duodenal Beneficial factors for the prognosis of patients with adenocarcinoma （P < 0.05）. Conclusion The prognosis of duodenal adenocarcinoma with metastasis is extremely poor, and early close monitoring is needed. Clinically, the prognosis of patients can be predicted by four indicators of metastasis, surgical method, Hp infection, and CA199.
- Duodenal adenocarcinoma /
- Clinical features /
- Prognosis

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图 1 十二指肠腺癌发生转移与否的生存时间对比

Figure 1. Survival time of duodenal adenocarcinoma with or without metastasis

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表 1 临床一般资料与十二指肠腺癌预后的单因素分析

Table 1. Univariate analysis of general clinical data and prognosis of adenocarcinoma of duodenum

变量	分组	n	生存率（%）			中位生存期（月）	χ²	P
变量	分组	n	1 a	3 a	5 a	中位生存期（月）	χ²	P
性别	男	52	92.9	54.5	24.5	16 ± 3.735	3.01	0.083
	女	36	76.8	36.6	0.0	22 ± 3.592
年龄（岁）	≤60	61	94.4	61.5	31.3	18 ± 2.784	0.717	0.397
	> 60	27	82.8	0.0	0.0	20 ± 1.749
BMI（kg/m²）	< 24	67	87.0	62.7	35.8	16 ± 2.293	1.650	0.199
	≥24	21	56.5	0.0	0.0	16 ± 7.273
KPS（分）	< 90	33	81.0	6.5	0.0	15 ± 3.464	1.914	0.167
	≥90	55	88.4	65.3	39.6	21 ± 4.021
吸烟史	有	23	61.6	0.0	0.0	15 ± 1.546	0.222	0.637
	无	65	85.2	59.9	35.0	17 ± 2.358
饮酒史	有	20	55.6	0.0	0.0	15 ± 1.789	0.032	0.857
	无	68	86.0	62.4	38.1	16 ± 2.696
转移	有	57	84.1	52.7	20.2	14 ± 2.603	6.073	0.014^*
	无	31	73.7	32.6	0.0	19 ± 3.996
原发灶部位	降部	75	95.1	69.9	41.5	18 ± 2.433	1.094	0.295
	其他	13	66.5	0.0	0.0	20 ± 1.577
原发灶直径（cm）	≤3	52	81.5	45.8	30.9	19 ± 2.255	8.650	0.003^*
	> 3	36	76.6	39.7	0.0	8 ± 2.022
临床分期	I-II	42	77.6	30.2	0.0	19 ± 2.100	4.353	0.037^*
	II-IV	46	81.3	51.2	0.0	13 ± 3.427
分化程度	低-中	56	85.7	50.3	20.2	16 ± 1.984	0.339	0.560
	中-高	32	75.3	34.9	0.0	16 ± 6.030
化疗方案	含氟尿嘧啶类	59	78.2	43.2	0.0	20 ± 2.188	5.236	0.022^*
	不含氟尿嘧啶类	29	68.2	18.9	0.0	15 ± 2.486
化疗药物种类	单药	25	65.5	12.3	0.0	14 ± 4.451	6.325	0.012^*
	双药及以上	63	81.3	43.4	37.6	20 ± 4.689
手术方式	胰十二指肠切除术	46	82.6	54.0	31.3	22 ± 4.233	23.903	0.001^*
	其他手术	8	55.6	33.3	0.0	15 ± 5.963
	无	34	75.0	12.2	0.0	9 ± 0.787
粪便隐血	阳性	33	78.1	20.3	0.0	20 ± 3.119	0.037	0.847
	阴性	55	86.9	60.2	29.3	20 ± 1.680
HP感染	阳性	38	79.6	30.5	0.0	11 ± 2.222	6.393	0.011^*
	阴性	50	82.5	50.3	32.7	20 ± 2.347
初诊时症状	1个	33	87.5	38.1	0.0	19 ± 3.493	1.649	0.648
	2个	38	83.3	25.9	0.0	16 ± 5.852
	3个	12	31.4	0.0	0.0	20 ± 1.829
	4个	5	0.0	0.0	0.0	14 ± 2.382
^*P < 0.05。

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表 2 血液学因素与十二指肠腺癌预后的单因素分析

Table 2. Univariate analysis of hematologic factors and prognosis of adenocarcinoma of duodenum

变量	分组	n	生存率（%）			中位生存期（月）	χ²	P
变量	分组	n	1 a	3 a	5 a	中位生存期（月）	χ²	P
CEA（ng/mL）	< 3.56	42	79.2	33.5	0.0	20 ± 3.639	9.749	0.002^*
	≥3.56	46	79.9	47.6	0.0	9 ± 2.833
CA199（U/mL）	≤27	48	79.7	43.5	27.3	20 ± 3.758	12.533	0.001^*
	> 27	40	77.4	41.4	12.9	9 ± 3.008
CA125（U/mL）	< 31.99	59	86.1	55.3	26.3	17 ± 2.276	1.539	0.215
	≥31.99	29	71.8	27.2	0.0	13 ± 4.402
ALT（U/L）	< 19	27	63.3	0.0	0.0	18 ± 2.733	0.667	0.414
	≥19	61	88.5	58.1	35.4	16 ± 2.642
AST/ALT	< 1.15	50	80.3	42.1	26.4	20 ± 2.387	12.081	0.001^*
	≥1.15	38	76.5	38.6	0.0	8 ± 0.993
NLR	< 1.64	18	42.9	0.0	0.0	20 ± 1.512	0.864	0.353
	≥1.64	70	89.7	61.4	44.8	15 ± 2.170
NKC	< 19.6%	57	84.6	62.0	30.1	15 ± 1.405	5.993	0.014^*
	≥19.6%	31	60.0	38.4	0.0	27 ± 21.51
Hb（g/L）	< 115	36	69.2	25.0	0.0	18 ± 2.075	0.765	0.382
	≥115	52	87.0	55.5	28.5	15 ± 4.254
PLT（×10⁹/L）	< 350	61	85.8	56.9	32.1	18 ± 2.306	8.512	0.004^*
	≥350	27	69.6	0.0	0.0	9 ± 3.131
白蛋白（g/L）	< 40	42	77.1	28.7	0.0	18 ± 2.309	3.028	0.082
	≥40	46	81.6	52.1	0.0	13 ± 4.104
LMR	< 5	53	84.8	48.2	30.4	19 ± 2.484	7.248	0.007^*
	≥5	35	78.5	34.9	0.0	9 ± 3.158
注：NLR = 中性粒细胞/淋巴细胞，NKC = 自然杀伤细胞，Hb = 血红蛋白，LMR = 淋巴细胞/单核细胞。^*P < 0.05。

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表 3 影响十二指肠腺癌预后的多因素分析

Table 3. Analysis of multiple factors influencing prognosis of duodenal adenocarcinoma

指标	B	SE	Wald	P	Exp（B）	HR（95%CI）
有无转移	0.716	0.349	4.197	0.041^*	2.045	（1.031，4.056）
临床分期	−0.899	0.703	1.634	0.201	0.407	（0.103，1.615）
原发灶直径	1.911	1.345	2.019	0.155	6.757	（0.484，94.257）
化疗方案	0.063	0.425	0.022	0.882	1.065	（0.463，2.450）
化疗药物种类	−0.560	0.364	2.360	0.125	0.571	（0.280，1.167）
手术方式	0.644	0.215	9.000	0.003^*	1.904	（1.250，2.899）
Hp感染	−0.849	0.372	5.205	0.023^*	0.428	（0.206，0.887）
CEA	−0.204	0.739	0.076	0.782	0.815	（0.192，3.469）
CA199	3.346	1.663	4.047	0.044^*	28.384	（1.090，739.064）
AST/ALT	0.084	1.027	0.007	0.935	1.088	（0.145，8.145）
PLT	0.580	0.658	0.777	0.378	1.786	（0.492，6.480）
NKC	−0.518	0.403	1.648	0.199	0.596	（0.270，1.314）
LMR	−2.486	1.305	3.631	0.057	0.083	（0.006，1.074）
年龄	1.564	1.588	0.969	0.325	4.776	（0.212，107.445）
吸烟史	0.406	0.608	0.447	0.504	1.502	（0.456，4.941）
饮酒史	0.353	0.607	0.338	0.561	1.423	（0.433，4.680）
^*P < 0.05。

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