胰腺癌治疗进展英文课件

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1、HowardA.Reber,MDProfessorofSurgeryUCLASchoolofMedicinePancreaticCancerSurgicalApproachintheUSA-2014AgiHirshbergCenterforPancreaticDiseasesatUCLAPancreaticCancerEpidemiology2014-46,420newcasesinUSA2014-39,590deaths4thmostcommoncancerkiller2ndmostcommonGIcanc

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

3、)LatePresentation-PoorSurvivalHowlanderetal,SEERCancerStatisticsReview2012.AmericanCancerSociety,CancerFacts&Figures2013.StageIIIIIIIVPercentatdiagnosis60%45%30%15%0%PancreaticResectionDistalPancreatectomy(noAppleby)Whippleoperation(Pancreaticoduodenectomy)S

4、tandardWhippleStandardWhippleRoux-en-YrarelydonePylorusPreservingWhippleCurerateissamewitheach..MostresectionsarePylorusPreservingWhipplesPylorusPreservingWhippleFactorsInfluencingSurvival182consecutivepatientsunderwentaWhippleforpancreaticcancerbetween1987a

5、nd2005.Patientsfrom1987-1995werecomparedwiththosefrom1996-2005.StudyDesignResultsSurvivalBiologicalfactorsrelatedtotumorDifferentiationNodalinvolvementPerineuralinvasionResectionmarginsDegreeofTumorDifferentiationActuarialsurvivalestimateforpatientswithwell,

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

7、omy(P<.001).38%(1987-2005)PerineuralInvasionNegativePositive36%13%Actuarialsurvivalforpatientswithadenocarcinomaofthepancreasundergoingpancreaticoduodenectomy(P<.001).36%(1987-2005)ResectionMarginsNegativePositive27%Biologicfeaturesofthetumorsthemselvesareth

8、eprimarydeterminantsofprognosis!27%157pts(1987-2005)R0R127.4%40.9%76.4%All182PtsSurvivalforEntireCohortAll182Pts(1987-2005)350mlEBL475mlEBL35.5%15.8%BloodLossInfluencesSurvivalAdjuvantTherapyTre