胰腺癌治疗进展英文

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1、HowardA.Reber,MDProfessorofSurgeryUCLASchoolofMedicinePancreaticCancerSurgicalApproachintheUSA-2014AgiHirshbergCenterforPancreaticDiseasesatUCLAPancreaticCancerEpidemiology2014-46,420newcasesinUSA2014-39,590deaths4thmostcommoncancerkiller2ndmostcommonGIc

2、ancerkiller(colon#1)PancreaticCancerEpidemiologyNewCancerDeaths,UnitedStates,2014.PancreaticCancerEpidemiologyIncidenceincreasing1%yearlyPancreaticCancerEpidemiology85%ofnewcasesareadvancedLocallyadvanced:bloodvessels(StageIII)Distantspreadtoliver,lungs(S

3、tageIV)LatePresentation-PoorSurvivalHowlanderetal,SEERCancerStatisticsReview2012.AmericanCancerSociety,CancerFacts&Figures2013.StageIIIIIIIVPercentatdiagnosis60%45%30%15%0%LatePresentation-PoorSurvivalHowlanderetal,SEERCancerStatisticsReview2012.AmericanC

4、ancerSociety,CancerFacts&Figures2013.24181260MedianSurvival(mos)StageIIIIIIIV0Even“early”stagediseaseisadvancedNoSurgeryIf..Majorbloodvesselsinvolved(StageIII)Distantmetastases(StageIV)SomeStageIIImaybeexceptionsPancreaticResectionDistalPancreatectomy(noA

5、ppleby)Whippleoperation(Pancreaticoduodenectomy)StandardWhippleStandardWhippleRoux-en-YrarelydonePylorusPreservingWhippleCurerateissamewitheach..MostresectionsarePylorusPreservingWhipplesPylorusPreservingWhippleFactorsInfluencingSurvival182consecutivepati

6、entsunderwentaWhippleforpancreaticcancerbetween1987and2005.Patientsfrom1987-1995werecomparedwiththosefrom1996-2005.StudyDesignResultsSurvivalBiologicalfactorsrelatedtotumorDifferentiationNodalinvolvementPerineuralinvasionResectionmarginsDegreeofTumorDiffe

7、rentiationActuarialsurvivalestimateforpatientswithwell,moderately,andpoorlydifferentiatedadenocarcinomaofthepancreas(P<.001).50%(1987-2005)LymphNodesNegativePositive28%22%Actuarialsurvivalfornode-negative(solidline)andnode-positive(dottedline)patientswith

8、adenocarcinomaofthepancreasundergoingapancreaticoduodenectomy(P<.001).38%(1987-2005)PerineuralInvasionNegativePositive36%13%Actuarialsurvivalforpatientswithadenocarcinomaofthepancreasundergoingpancreaticoduodenectom