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1.中山大学孙逸仙纪念医院急诊科,广东 广州,510120
2.中山大学孙逸仙纪念医院麻醉科,广东 广州,510120
陈慧,第一作者,研究方向:衰弱和脓毒症,E-mail: chenh387@mail.sysu.edu.cn
收稿日期:2024-12-04,
录用日期:2025-04-02,
纸质出版日期:2025-05-20
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陈慧,范桂芬,许冬妮等.术前衰弱对胰腺癌患者胰十二指肠切除术后预后的影响[J].中山大学学报(医学科学版),2025,46(03):512-518.
CHEN Hui,FAN Guifen,XU Dongni,et al.Effect of Preoperative Frailty on Prognosis of Pancreatic Cancer Patients after Pancreaticoduodenectomy[J].Journal of Sun Yat-sen University(Medical Sciences),2025,46(03):512-518.
陈慧,范桂芬,许冬妮等.术前衰弱对胰腺癌患者胰十二指肠切除术后预后的影响[J].中山大学学报(医学科学版),2025,46(03):512-518. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2025.0316.
CHEN Hui,FAN Guifen,XU Dongni,et al.Effect of Preoperative Frailty on Prognosis of Pancreatic Cancer Patients after Pancreaticoduodenectomy[J].Journal of Sun Yat-sen University(Medical Sciences),2025,46(03):512-518. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2025.0316.
目的
2
探讨术前衰弱指数对胰腺癌患者胰十二指肠切除术后预后的影响。
方法
2
对中山大学孙逸仙纪念医院435例行胰十二指肠切除术的胰腺癌患者的临床资料进行回顾性分析,统计患者术前衰弱情况,衰弱评估方法为衰弱(FRAIL)问卷。采用二元Logistics回归分析探讨衰弱的影响因素,采用Cox回归进行生存分析,按照人口学特征进行亚组分析并探讨衰弱对于胰腺癌患者胰十二指肠术后预后的影响。
结果
2
本研究共纳入患者435例,119例发生衰弱(占27.4%),316例无衰弱(占72.7%)。两组患者在年龄、BMI、ASA评分、术后输注红细胞、术后腹腔脓肿、CA199 、CA125、AFP、白细胞、中性粒细胞、HDL和疼痛程度等指标有显著性差异(
P
<0.0
5)。高龄、ASA评分3级是衰弱的危险因素,HDL是衰弱的保护因素。非衰弱组的生存时间优于衰弱组。HDL是影响预后的独立保护因素,LDL是独立的危险因素。
结论
2
本研究表明术前衰弱状态是胰腺癌患者行胰十二指肠切除术后预后不良的重要预测因素。对于胰腺癌患者,术前应进行衰弱评估,并采取相应措施以改善患者的营养和代谢状况,以期提高术后生存率和生活质量。
Objective
2
To investigate the impact of preoperative frailty on the prognosis of patients with pancreatic cancer who underwent pancreaticoduodenectomy.
Methods
2
A retrospective analysis was conducted on the clinical data of 435 pancreatic cancer patients who underwent pancreaticoduodenectomy at Sun Yat-sen Memorial Hospital of Sun Yat-sen University. Preoperative frailty was assessed using the FRAIL questionnaire. Binary logistics regression analysis was employed to identify factors influencing frailty, and Cox regression analysis was used to evaluate the effect of frailty on survival. According to the demographic characteristics, subgroup analyses were performed on the effect of frailty on prognosis of patients with pancreatic cancer with pancreaticoduodenectomy.
Results
2
Among the 435 patients enrolled, 119 (27.4%) exhibited frailty, while 316 (72.6%) did not. Significant differences were observed between the two groups in various clinical parameters, including age, body mass index, American Society of Anesthesiologists (ASA) score, postoperative red blood cell transfusion, postoperative abdominal abscess, serum levels of glycoantigens 199, glycoantigens 125, and alpha fetoprotein, leukocyte count, neutrophil, high density lipoprotein (HDL) level, and pain intensity (
P
<0.05). Advanced age and an ASA score of Ⅲ were identified as risk factors for frailty, whereas HDL level was a protective factor. Non-frail patients had better postoperative survival times than frail patients. HDL was determined to be an independent protective factor for prognosis, while LDL was an independent risk factor.
Conclusions
2
This study demonstrates that preoperative frailty is a significant predictor of poor prognosis in pancreatic cancer patients who underwent pancreaticoduodenectomy.These findings suggest that preoperative frailty assessment and targeted interventions to improve nutritional and metabolic status could potentially enhance postoperative survival and quality of life in pancreatic cancer patients.
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