CAJ | 학술논문

目的：探讨血清C反应蛋白（ CRP ）动态变化与晚期胰腺癌一线化疗疗效及预后的关系。方法根据基线CRP水平和一线化疗过程中CRP动态变化将上海交通大学胰腺癌诊治中心2008年12月至2013年12月收治的61例晚期胰腺癌患者分为4组：A1组20例，CRP基线水平升高（≥5mg／L）且化疗过程中维持高水平；A2组11例，CRP基线水平升高且化疗过程中至少1次恢复正常（＜5mg／L）；B1组17例，CRP基线水平正常且化疗过程中至少1次升高；B2组13例，CRP基线水平正常且化疗过程中维持正常。采用RECIST 1?1标准评价疗效，随访生存资料并分析患者预后情况，采用Cox比例风险回归模型分析影响晚期胰腺癌一线化疗预后的独立因素。结果61例患者均可评价疗效，无获CR者，其中PR 6例，SD 25例， PD 30例，疾病控制率（ DCR）为50?82％；截止2013年12月31日，死亡54例，存活7例，中位生存期（ OS）为7?20个月，中位无进展生存期（ PFS）为3?03个月；A1、A2、B1、B2组的DCR分别为35?0％、54?6％、41?2％和84?6％，中位OS分别为4?97、8?87、7?20、10?47个月，中位PFS分别为1?97、3?83、3?20、6?90个月，以上差异均有统计学意义（ P＜0?05）；Cox多因素分析结果显示，基线CRP、CRP动态变化、白蛋白及CA19?9水平为影响晚期胰腺癌预后的独立因素。结论 CRP可作为判断晚期胰腺癌患者临床预后的标志之一，基线CRP水平和一线化疗过程中CRP动态变化是晚期胰腺癌患者的独立预后因素。
목적：탐토혈청C반응단백（ CRP ）동태변화여만기이선암일선화료료효급예후적관계。방법근거기선CRP수평화일선화료과정중CRP동태변화장상해교통대학이선암진치중심2008년12월지2013년12월수치적61례만기이선암환자분위4조：A1조20례，CRP기선수평승고（≥5mg／L）차화료과정중유지고수평；A2조11례，CRP기선수평승고차화료과정중지소1차회복정상（＜5mg／L）；B1조17례，CRP기선수평정상차화료과정중지소1차승고；B2조13례，CRP기선수평정상차화료과정중유지정상。채용RECIST 1?1표준평개료효，수방생존자료병분석환자예후정황，채용Cox비례풍험회귀모형분석영향만기이선암일선화료예후적독립인소。결과61례환자균가평개료효，무획CR자，기중PR 6례，SD 25례， PD 30례，질병공제솔（ DCR）위50?82％；절지2013년12월31일，사망54례，존활7례，중위생존기（ OS）위7?20개월，중위무진전생존기（ PFS）위3?03개월；A1、A2、B1、B2조적DCR분별위35?0％、54?6％、41?2％화84?6％，중위OS분별위4?97、8?87、7?20、10?47개월，중위PFS분별위1?97、3?83、3?20、6?90개월，이상차이균유통계학의의（ P＜0?05）；Cox다인소분석결과현시，기선CRP、CRP동태변화、백단백급CA19?9수평위영향만기이선암예후적독립인소。결론 CRP가작위판단만기이선암환자림상예후적표지지일，기선CRP수평화일선화료과정중CRP동태변화시만기이선암환자적독립예후인소。
Objective To investigate the relationship between C?reactive protein(CRP) kinetics and efficacy of the first?line chemotherapy and prognosis, as to analyze whether CRP can be one of the biological markers indicating the clinical prognosis of ad?vanced pancreatic cancer. Methods Sixty?one patients with advanced pancreatic cancer in dignosis and treatment center of pancreatic cancer affiliated to Shanghai Jiaotong university from December 2008 to December 2013 were enrolled in this study. The 61 cases were assigned into four groups according to baseline CRP and CRP kinetics: group A1, patients whose baseline CRP≥5mg/L and never normalized( CRP<5mg/L) during treatment;group A2, patients whose baseline CRP≥5mg/L and normalized at least one time during treatment;group B1, patients whose baseline CRP<5mg/L and elevated( CRP≥5mg/L) at least one time during treatment and group B2, patients whose baseline CRP<5mg/L and never elevated during treatment. The RECIST 1?1 criteria were used to evaluate the cur?ative effect of overall and different CRP group. The Survival data were followed up and analyzed among different groups. The COX pro?portional hazard regression model was employed to analyze the independent prognostic factors of first?line chemotherapy for advanced pancreatic cancer. Results All patients were evaluable for efficacy. The disease control rate( DCR) was 50?82% including PR 6 ca?ses, SD 25 cases and PD 4 cases. Until December 31, 2013, 54 cases died and 7 cases survived with medium overall survival( OS) of 7?2 months and medium progression?free survival(PFS) of 3?03 months. The DCR, medium OS and PFS of A1, A2, B1 and B2 groups were 35?0%, 54?6%, 41?2% and 84?6%, 4?97, 8?87, 7?20 and 10?47 months, and 1?97, 3?83, 3?20, 6?90 months all with significant difference( P<0?05) . The independent prognostic factors in patients with advanced pancreatic cancer includes baseline CRP, the dynamic changes of CRP, albumin and CA19?9 levels. Conclusion CRP is one of the biological markers indicating the clinical prognosis of advanced pancreatic cancer. Baseline CRP and CRP kinetics during first?line chemotherapy are independent factors for prognosis of advanced pancreatic cancer.