晚期胰腺癌预后的多因素分析
摘要
目的:应用Cox比例风险模型分析晚期胰腺癌预后的因素,并探讨支持治疗、姑息手术和姑息手术联合放射治疗的疗效。方法:2004年3月～2007年2月,我院对109例无法切除的胰腺癌分别行支持治疗55例,胆肠吻合术(姑息手术)26例及姑息手术联合放射治疗28例。将年龄、性别、族别、一般状况、肿瘤分期、肿瘤部位、治疗方式等因素进行单因素分析,将单因素分析有显著性意义的变量引入Cox比例风险模型进行多因素分析。治疗后疼痛缓解程度比较应用χ2检验;放疗前后CA-199水平的比较用t’检验。结果:单因素分析显示,KS评分和治疗方式对预后有统计学意义。Cox比例风险模型显示,仅治疗方式对预后有统计学意义。支持治疗组中治疗前疼痛的49例,治疗后疼痛部分缓解率及完全缓解率分别为32.65%(16/49)及4.08%(2/49);姑息手术组中治疗前疼痛的21例,治疗后疼痛部分缓解率及完全缓解率分别为38.09%(8/21)及4.76%(1/21);姑息手术联合放射治疗组,术前的疼痛的21例,术后疼痛部分缓解率及完全缓解率分别为14.29%(3/21)及76.19%(16/21)。可见姑息手术联合放射治疗组疼痛部分缓解率及完全缓解率显著高于其它两组(P=0.0001)。支持治疗组和姑息手术组中CA-199水平在治疗前后变化无统计学意义,姑息手术联合放射治疗组中治疗后CA-199水平21.2±4.5u/ml,较治疗前231.6±32.9u/ml显著降低,其变化有统计学意义(F=53.4523, P=0.0000)。姑息手术联合放射治疗组的中位生存时间(42.3周)显著长于姑息手术组(17.1周)及支持治疗组(9.5周)(P=0.0000)。结论:治疗方式是影响预后的主要因素。对于不能耐受手术的晚期胰腺癌姑息手术联合放射治疗,在延长生存期的同时可明显缓解患者的疼痛,并降低CA-199水平。
Objective: To study the relative factors affecting the prognosis of advanced pancreatic carcinoma with Cox proportional hazard model, and effectiveness of radiotherapy combined with palliative operation. Methods: 109 patients with unresectable and advanced pancreatic carcinoma admitted from Mar.2004 to Feb. 2007 were analyzed with Cox proportional hazard model. 55 cases were treated by the supportive care; 26 cases by palliative operation and 28 cases by palliative operation combined with radiotherapy, respectively. Radiotherapy including iodine125 seed implantation(16 cases) and 3D conformal radiotherapy(12 cases).χ2 test for pain relieving rate pre- and post- radiotherapy; t’test for CA-199 levels before and after the radiotherapy. Results:The major factors affecting prognosis was treatment. Palliative operation combined with radiotherapy could reduce the death risk 7.83 times than other treatments. Among the 21 patients who suffered pain before radiotherapy, complete response was obtained in 76.19%(16/21), partial response in 14.29%(3/21) which is significantly higher than that of other two groups (P=0.0001). The level of CA-199 (21.2±4.5u/ml) after radiotherapy was significantly lower than that of before radiotherapy(231.6±32.9u/ml) (F=53.4523, P=0.0000).The median survival time in combined group was 42.3 weeks, which was significantly longer than that of other two groups (17.1 weeks, 9.5weeks). Conclusion : Palliative operation combined with radiotherapy would improve the prognosis of advanced pancreatic carcinoma. It does show some therapeutic effects for advanced pancreatic carcinoma, in terms of pain relieving rate, CA-199 levels and median survival time.
Objective: To study the relative factors affecting the prognosis of advanced pancreatic carcinoma with Cox proportional hazard model, and effectiveness of radiotherapy combined with palliative operation. Methods: 109 patients with unresectable and advanced pancreatic carcinoma admitted from Mar.2004 to Feb. 2007 were analyzed with Cox proportional hazard model. 55 cases were treated by the supportive care; 26 cases by palliative operation and 28 cases by palliative operation combined with radiotherapy, respectively. Radiotherapy including iodine125 seed implantation(16 cases) and 3D conformal radiotherapy(12 cases).χ2 test for pain relieving rate pre- and post- radiotherapy; t’test for CA-199 levels before and after the radiotherapy. Results:The major factors affecting prognosis was treatment. Palliative operation combined with radiotherapy could reduce the death risk 7.83 times than other treatments. Among the 21 patients who suffered pain before radiotherapy, complete response was obtained in 76.19%(16/21), partial response in 14.29%(3/21) which is significantly higher than that of other two groups (P=0.0001). The level of CA-199 (21.2±4.5u/ml) after radiotherapy was significantly lower than that of before radiotherapy(231.6±32.9u/ml) (F=53.4523, P=0.0000).The median survival time in combined group was 42.3 weeks, which was significantly longer than that of other two groups (17.1 weeks, 9.5weeks). Conclusion : Palliative operation combined with radiotherapy would improve the prognosis of advanced pancreatic carcinoma. It does show some therapeutic effects for advanced pancreatic carcinoma, in terms of pain relieving rate, CA-199 levels and median survival time.
引文
[1] Kim R, Saif MW. Is there an optimal neoadjuvant therapy for locally advanced pancreatic cancer?.〔J〕JOP, 2007,8:279-288.
[2]张丽萍,聂青,等.伽玛刀治疗晚期胰腺癌的临床研究[J]中国现代医学杂志,2005,15(5):723~725.
[3]侯宇,李岚,杨胜刚,等.三维适形放疗在局部进展期胰腺癌中的应用[J].现代肿瘤医学,2004,6(3):267~269.
[4] Wilkowski R, Thoma M, Bruns C, et al . Chemoradiotherapy with gemcitabine and continuous 5 - FU in patientswith p rimary inoper2 able pancreatic cancer[ J ]. JOP, 2006, 7 (4) : 349～360.
[5]吴荣,贾明轩,郭启勇.三维适形放射治疗对局部中晚期胰腺癌的临床意义.中国医科大学学报, 2004, 33 (2) : 142 - 143, 146.
[6] Martenson JA, Vigliotti AP, Pitot HC, et al. A phase I study of radiation therapy and twice-weekly gemcitabine and cisplatin in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys, 2003, 55(4): 1305- 1310.
[7] Boz G, De Paoli A, Innocente R, et al. Radiotherapy and chemotherapy in pancreatic cancer. Topical issues and future perspectives.〔J〕JOP, 2006,7:122-130.
[8] Chang Q, Qin R, Huang T, et al. Effect of antisense hypoxia-inducible factor 1alpha on progression, metastasis, and chemosensitivity of pancreatic cancer. Pancreas, 2006,32:297-305.
[9]张群华,倪泉兴.胰腺癌2340例临床病例分析[J].中华医学杂志,2004,84(3): 214- 218.
[10]彭承宏.胰十二指肠切除术术中难点及其处理[J].外科理论与实践, 2005,10(3):212- 213.
[11] Liu S, Wang XP, Brunicardi FC. Enhanced cytotoxicity of RIPTK gene therapy of pancreatic cancer via PDX-1 co-delivery. J Surg Res, 2007,137:1-9.
[12] Tsuda N, Ishiyama S, Li Y, et al. Synthetic microRNA designed to target glioma-associated antigen 1 transcription factor inhibits division and induces late apoptosis in pancreatic tumor cells. Clin Cancer Res, 2006,12:6557-64.
[13] Eisold S, Antolovic D, Schmidt J, et al. Effective antitumoral immune responses are not induced by cytosine deaminase suicide gene transfer in a syngeneic ratpancreatic carcinoma model. Eur Surg Res, 2006,38:513-21.
[14] Freelove R, Walling AD. Pancreatic cancer: diagnosis and management. Am Fam Physician, 2006,73:485-92.
[15] Huch M, Abate-Daga D, Roig JM, et al. Targeting the CYP2B 1/cyclophosphamide suicide system to fibroblast growth factor receptors results in a potent antitumoral response in pancreatic cancer models. Hum Gene Ther, 2006,17:1187-200.
[16]王俊杰,白静,修典荣,等.放射性125I粒子组织间植入治疗胰腺癌的疗效。〔J〕中华普通外科杂志,2004,19(8):512-514.
[17]孙燕.胰腺癌内科治疗和综合治疗.癌症进展杂志2004:2(9)367-369
[18]赵玉沛,蔡力行.肿瘤标志物联合检测在胰腺诊断及随访中的应用.中华肝胆外科杂志, 1999, 5 (2) : 1002103
[19]邓登豪,朱海杭.胰腺癌肿瘤标志物单项和联合检测的价值.胃肠病学和肝病学杂志, 2001, 10 (1) : 60262
[20]孔宪涛.肿瘤特异抗原的研究现状及检测[ J ].中华检验医学杂志,2000, 23 (1) : 56
[21]王自正.现代医学标记免疫学[M ].北京:人民医院出版社, 2000.59
[22] Cardenes HR, Chiorean EG, Dewitt J, et al. Locally advanced pancreatic cancer: current therapeutic approach. Oncologist, 2006,11:612-23.
[23] Tsujie M, Nakamori S, Tanaka E, et al. Phase I/II trial of hyperfractionated accelerated chemoradiotherapy for unresectable advanced pancreatic cancer. Jpn J Clin Oncol, 2006,36:504-10.
[24] Silvestri A, Peparini N. Oncological surgery of the pancreas and bile ducts: current therapeutic prospects. G Chir, 2006,27:401-4.
[25] Willett CG, Del Castillo CF, Shih HA, et al. Long-term results of intraoperative electron beam irradiation (IOERT) for patients with unresectable pancreatic cancer. Ann Surg, 2005,241:295-9.
[26] Saif MW, Moody JS, Russo SM. Gastrointestinal bleeding associated with concurrent capecitabine and radiotherapy in patients with pancreatic cancer. JOP, 2005,6:325-33.
[1] Kim R, Saif MW. Is there an optimal neoadjuvant therapy for locally advanced pancreatic cancer?. JOP, 2007,8:279-88.
[2] Brunner TB, Grabenbauer GG, Meyer T, et al. Primary resection versus neoadjuvant chemoradiation followed by resection for locally resectable or potentially resectable pancreatic carcinoma without distant metastasis. A multi-centre prospectively randomised phase II-study of the Interdisciplinary Working Group Gastrointestinal Tumours (AIO, ARO, and CAO). BMC Cancer, 2007,7:41.
[3] Fernandez-Cruz L, Olvera C, Lopez-Boado MA, et al. Organ-preserving resection of the pancreaticoduodenal region in the treatment of intraductal papillary mucinous tumors. Cir Esp, 2006,80:295-300.
[4] Silvestri A, Peparini N. Oncological surgery of the pancreas and bile ducts: current therapeutic prospects. G Chir, 2006,27:401-4.
[5] Nakao A, Fujii T, Sugimoto H, et al. Oncological problems in pancreatic cancer surgery. World J Gastroenterol, 2006,12:4466-72.
[6] Qian XJ, Zhai RY, Dai DK, et al. Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment. World J Gastroenterol, 2006,12:331-5.
[7] Adhoute X, Smith D, Vendrely V, et al. Subsequent resection of locally advanced pancreatic carcinoma after chemoradiotherapy. Gastroenterol Clin Biol, 2006,30:224-30.
[8] Saif MW. Pancreatic cancer: highlights from the 42nd annual meeting of the American Society of Clinical Oncology, 2006. JOP, 2006,7:337-48.
[9] Wilkowski R, Thoma M, Bruns C, et al. Chemoradiotherapy with gemcitabine and continuous 5-FU in patients with primary inoperable pancreatic cancer. JOP, 2006,7:349-60.
[10] Xie DR, Liang HL, Wang Y, et al. Meta-analysis on inoperable pancreatic cancer: a comparison between gemcitabine-based combination therapy and gemcitabine alone. World J Gastroenterol, 2006,12:6973-81.
[11] Okusaka T, Ishii H, Funakoshi A, et al. A phase I/II study of combination chemotherapy with gemcitabine and 5-fluorouracil for advanced pancreatic cancer. Jpn J Clin Oncol, 2006,36:557-63.
[12] Bachet JB, Mitry E, Lepere C, et al. Chemotherapy as initial treatment of locally advanced unresectable pancreatic cancer: a valid option?. Gastroenterol Clin Biol, 2007,31:151-6.
[13] Chang Q, Qin R, Huang T, et al. Effect of antisense hypoxia-inducible factor 1alpha on progression, metastasis, and chemosensitivity of pancreatic cancer. Pancreas, 2006,32:297-305.
[14] Yekebas EF, Bogoevski D, Bubenheim M, et al. Strong prognostic value of nodal and bone marrow micro-involvement in patients with pancreatic ductal carcinoma receiving no adjuvant chemotherapy. World J Gastroenterol, 2006,12:6515-21.
[15] Garofalo MC, Regine WF, Tan MT. On statistical reanalysis, the EORTC trial is a positive trial for adjuvant chemoradiation in pancreatic cancer. Ann Surg, 2006,244:332-3; author reply 333.
[16] Tsujie M, Nakamori S, Tanaka E, et al. Phase I/II trial of hyperfractionated accelerated chemoradiotherapy for unresectable advanced pancreatic cancer. Jpn J Clin Oncol, 2006,36:504-10.
[17] Boz G, De Paoli A, Innocente R, et al. Radiotherapy and chemotherapy in pancreatic cancer. Topical issues and future perspectives. JOP, 2006,7:122-30.
[18] Kim R, Saif MW_ Is there an Optimal Neoadjuvant Therapy for Locally Advanced Pancreatic Cancer_ JOP_ J Pancreas (Online) 2007; 8(3)279-288_ [Full text].
[19] Cardenes HR, Chiorean EG, Dewitt J, et al. Locally advanced pancreatic cancer:current therapeutic approach. Oncologist, 2006,11:612-23.
[20] Thomson BN, Banting SW, Gibbs P. Pancreatic cancer - current management. Aust Fam Physician, 2006,35:212-7.
[21]倪泉兴,傅德良。胰腺癌的介入治疗及临床评价。中国实用外科杂志2003:23(12)713-715
[22]郑家平,叶强,顾伟中。胰腺癌的血管介入治疗。介入放射学杂志2004:13(14)373-375
[23] Wilkowski R, Thoma M, Bruns C, et al. Combined chemoradiotherapy for isolated local recurrence after primary resection of pancreatic cancer. JOP, 2006,7:34-40.
[24] Saif MW, Moody JS, Russo SM. Gastrointestinal bleeding associated with concurrent capecitabine and radiotherapy in patients with pancreatic cancer. JOP, 2005,6:325-33.
[25] Wilkowski R, Thoma M, Weingandt H, et al. Chemoradiation for ductal pancreatic carcinoma: principles of combining chemotherapy with radiation, definition of target volume and radiation dose. JOP, 2005,6:216-30.
[26] Willett CG, Del Castillo CF, Shih HA, et al. Long-term results of intraoperative electron beam irradiation (IOERT) for patients with unresectable pancreatic cancer. Ann Surg, 2005,241:295-9.
[27]王俊杰,白静,修典荣,等。放射性125I粒子组织间植入治疗胰腺癌的疗效。中华普通外科杂志2004:19(8)512-514
[28]金震东,李兆申,刘岩,等。超声内镜引导下定向植入放射性125I粒子治疗胰腺癌的临床研究.。中华消化内镜杂志2006:23(1)15-18
[29]李欣,修典荣,王俊杰,等。放射介入、姑息手术以及姑息手术联合～125I粒子植入治疗晚期胰腺癌临床疗效比较.中国微创外科杂志2006:6(4)287-289
[30]李力军,封国生,刘璐,等。125I籽源与缓释化疗粒子联合植入靶向治疗进展期胰腺癌。东南大学学报2004:23(4)246-249
[31] El-Metwally TH, Pour PM. The retinoid induced pancreatic cancer redifferentiation apoptosis sequence and the mitochondria: a suggested obligatory sequence of events. JOP JT - JOP : Journal of the pancreas, 2007,8:268-78.
[32]杨国凯,罗开元,杨镛,等。125I粒子永久性植入组织间治疗胰腺癌的临床报告.临床外科杂志2003:11(2)92-95
[33]周伟,钟毓斌,洛小林,等。术中125I粒子植入与高能电子线放射治疗晚期胰腺癌的比较。中日友好医院学报2005:19(4)218-222
[34] Liu S, Wang XP, Brunicardi FC. Enhanced cytotoxicity of RIPTK gene therapy ofpancreatic cancer via PDX-1 co-delivery. J Surg Res, 2007,137:1-9.
[35] Tsuda N, Ishiyama S, Li Y, et al. Synthetic microRNA designed to target glioma-associated antigen 1 transcription factor inhibits division and induces late apoptosis in pancreatic tumor cells. Clin Cancer Res, 2006,12:6557-64.
[36] Eisold S, Antolovic D, Schmidt J, et al. Effective antitumoral immune responses are not induced by cytosine deaminase suicide gene transfer in a syngeneic rat pancreatic carcinoma model. Eur Surg Res, 2006,38:513-21.
[37] Freelove R, Walling AD. Pancreatic cancer: diagnosis and management. Am Fam Physician, 2006,73:485-92.
[38] Huch M, Abate-Daga D, Roig JM, et al. Targeting the CYP2B 1/cyclophosphamide suicide system to fibroblast growth factor receptors results in a potent antitumoral response in pancreatic cancer models. Hum Gene Ther, 2006,17:1187-200.
[39] Lu Y, Bai JG, Wang HH. Gene therapeutic treatment of pancreatic cancer based on injection of pcDNA3.1/CCK plasmid with xenogeneic homologous cholecystokinin. Exp Oncol, 2006,28:136-40.
[40] Kunisaki R, Ikawa S, Maeda T, et al. p51/p63, a novel p53 homologue, potentiates p53 activity and is a human cancer gene therapy candidate. J Gene Med, 2006,8:1121-30.
[41]王亚利,宋天宝,王西京等。SurvivinmRNA反义寡核苷酸诱导胰腺癌细胞凋亡。世界华人消化杂志2004:12(8)1872-1874
[42] Wang YF, Guo KJ, Huang BT, et al. Inhibitory effects of antisense phosphorothioate oligodeoxynucleotides on pancreatic cancer cell Bxpc-3 telomerase activity and cell growth in vitro. World J Gastroenterol, 2006,12:4004-8.
[43] Hara H, Kobayashi A, Yoshida K, et al. Local interferon-alpha gene therapy elicits systemic immunity in a syngeneic pancreatic cancer model in hamster. Cancer Sci, 2007,98:455-63.
[44] Cohenuram M, Saif MW_ Epidermal Growth Factor Receptor Inhibition Strategies in Pancreatic Cancer Past, Present and the Future_ JOP_ J Pancreas (Online) 2007; 8(1)4-15_ [Full text].
[45] Capello A, Krenning EP, Bernard BF, et al. Anticancer activity of targeted proapoptotic peptides. J Nucl Med, 2006,47:122-9.
[46] Yao JC. Neuroendocrine tumors. Molecular targeted therapy for carcinoid and islet-cell carcinoma. Best Pract Res Clin Endocrinol Metab, 2007,21:163-72.
[47] Krempien R, Muenter MW, Huber PE, et al. Randomized phase II--study evaluatingEGFR targeting therapy with cetuximab in combination with radiotherapy and chemotherapy for patients with locally advanced pancreatic cancer--PARC: study protocol [ISRCTN56652283]. BMC Cancer, 2005,5:131.
[48] Cohenuram M, Saif MW. Epidermal growth factor receptor inhibition strategies in pancreatic cancer: past, present and the future. JOP, 2007,8:4-15.
[49]李俊生,汤文浩。ZD1839对胰腺癌细胞的生长抑制作用及机理。肝胆外科杂志2007:15(1)59-62
[50]张波,赵玉沛,刘卫平等。光动力治疗裸鼠胰腺癌及其机理的实验研究.中国普外基础与临床杂志2003:10(1)30-33
[51]章明,白向君,李伟兵等。高强度聚焦超声治疗晚期胰腺癌,实用肿瘤学杂志,2004:14(4)126-129
[52] Polymeric nanoparticle-encapsulated curcumin (nanocurcumin) a novel strategy for human cancer therapy.
[53] Fazal S, Saif MW. Supportive and palliative care of pancreatic cancer. JOP, 2007,8:240-53.
[54] Brasiuniene B, Brasiunas V, Juozaityte E. [Effect of combined treatment methods on quality of life in patients with pancreatic cancer]. Medicina (Kaunas), 2006,42:817-22.
[55] Lohr JM. Medical treatment of pancreatic cancer. Expert Rev Anticancer Ther, 2007,7:533-44.
[56]刘瑞林,徐云,徐祗永等.姑息性综合治疗晚期胰腺癌39例临床观察.胃肠病学和肝病学杂志2005:14(3)306-309
[57] Peron JM, Bureau C, Gourdy P, et al. Treatment of experimental murine pancreatic peritoneal carcinomatosis with fibroblasts genetically modified to express IL12: a role for peritoneal innate immunity. Gut, 2007,56:107-14.
[58]孙燕.胰腺癌内科治疗和综合治疗.癌症进展杂志2004:2(9)367-369
[59] Brasiuniene B, Juozaityte E, Barauskas G. Impact of different treatment methods on survival in advanced pancreatic cancer. Medicina (Kaunas), 2005,41:382-5.
[2]张丽萍,聂青,等.伽玛刀治疗晚期胰腺癌的临床研究[J]中国现代医学杂志,2005,15(5):723~725.
[3]侯宇,李岚,杨胜刚,等.三维适形放疗在局部进展期胰腺癌中的应用[J].现代肿瘤医学,2004,6(3):267~269.
[4] Wilkowski R, Thoma M, Bruns C, et al . Chemoradiotherapy with gemcitabine and continuous 5 - FU in patientswith p rimary inoper2 able pancreatic cancer[ J ]. JOP, 2006, 7 (4) : 349～360.
[5]吴荣,贾明轩,郭启勇.三维适形放射治疗对局部中晚期胰腺癌的临床意义.中国医科大学学报, 2004, 33 (2) : 142 - 143, 146.
[6] Martenson JA, Vigliotti AP, Pitot HC, et al. A phase I study of radiation therapy and twice-weekly gemcitabine and cisplatin in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys, 2003, 55(4): 1305- 1310.
[7] Boz G, De Paoli A, Innocente R, et al. Radiotherapy and chemotherapy in pancreatic cancer. Topical issues and future perspectives.〔J〕JOP, 2006,7:122-130.
[8] Chang Q, Qin R, Huang T, et al. Effect of antisense hypoxia-inducible factor 1alpha on progression, metastasis, and chemosensitivity of pancreatic cancer. Pancreas, 2006,32:297-305.
[9]张群华,倪泉兴.胰腺癌2340例临床病例分析[J].中华医学杂志,2004,84(3): 214- 218.
[10]彭承宏.胰十二指肠切除术术中难点及其处理[J].外科理论与实践, 2005,10(3):212- 213.
[11] Liu S, Wang XP, Brunicardi FC. Enhanced cytotoxicity of RIPTK gene therapy of pancreatic cancer via PDX-1 co-delivery. J Surg Res, 2007,137:1-9.
[12] Tsuda N, Ishiyama S, Li Y, et al. Synthetic microRNA designed to target glioma-associated antigen 1 transcription factor inhibits division and induces late apoptosis in pancreatic tumor cells. Clin Cancer Res, 2006,12:6557-64.
[13] Eisold S, Antolovic D, Schmidt J, et al. Effective antitumoral immune responses are not induced by cytosine deaminase suicide gene transfer in a syngeneic ratpancreatic carcinoma model. Eur Surg Res, 2006,38:513-21.
[14] Freelove R, Walling AD. Pancreatic cancer: diagnosis and management. Am Fam Physician, 2006,73:485-92.
[15] Huch M, Abate-Daga D, Roig JM, et al. Targeting the CYP2B 1/cyclophosphamide suicide system to fibroblast growth factor receptors results in a potent antitumoral response in pancreatic cancer models. Hum Gene Ther, 2006,17:1187-200.
[16]王俊杰,白静,修典荣,等.放射性125I粒子组织间植入治疗胰腺癌的疗效。〔J〕中华普通外科杂志,2004,19(8):512-514.
[17]孙燕.胰腺癌内科治疗和综合治疗.癌症进展杂志2004:2(9)367-369
[18]赵玉沛,蔡力行.肿瘤标志物联合检测在胰腺诊断及随访中的应用.中华肝胆外科杂志, 1999, 5 (2) : 1002103
[19]邓登豪,朱海杭.胰腺癌肿瘤标志物单项和联合检测的价值.胃肠病学和肝病学杂志, 2001, 10 (1) : 60262
[20]孔宪涛.肿瘤特异抗原的研究现状及检测[ J ].中华检验医学杂志,2000, 23 (1) : 56
[21]王自正.现代医学标记免疫学[M ].北京:人民医院出版社, 2000.59
[22] Cardenes HR, Chiorean EG, Dewitt J, et al. Locally advanced pancreatic cancer: current therapeutic approach. Oncologist, 2006,11:612-23.
[23] Tsujie M, Nakamori S, Tanaka E, et al. Phase I/II trial of hyperfractionated accelerated chemoradiotherapy for unresectable advanced pancreatic cancer. Jpn J Clin Oncol, 2006,36:504-10.
[24] Silvestri A, Peparini N. Oncological surgery of the pancreas and bile ducts: current therapeutic prospects. G Chir, 2006,27:401-4.
[25] Willett CG, Del Castillo CF, Shih HA, et al. Long-term results of intraoperative electron beam irradiation (IOERT) for patients with unresectable pancreatic cancer. Ann Surg, 2005,241:295-9.
[26] Saif MW, Moody JS, Russo SM. Gastrointestinal bleeding associated with concurrent capecitabine and radiotherapy in patients with pancreatic cancer. JOP, 2005,6:325-33.
[1] Kim R, Saif MW. Is there an optimal neoadjuvant therapy for locally advanced pancreatic cancer?. JOP, 2007,8:279-88.
[2] Brunner TB, Grabenbauer GG, Meyer T, et al. Primary resection versus neoadjuvant chemoradiation followed by resection for locally resectable or potentially resectable pancreatic carcinoma without distant metastasis. A multi-centre prospectively randomised phase II-study of the Interdisciplinary Working Group Gastrointestinal Tumours (AIO, ARO, and CAO). BMC Cancer, 2007,7:41.
[3] Fernandez-Cruz L, Olvera C, Lopez-Boado MA, et al. Organ-preserving resection of the pancreaticoduodenal region in the treatment of intraductal papillary mucinous tumors. Cir Esp, 2006,80:295-300.
[4] Silvestri A, Peparini N. Oncological surgery of the pancreas and bile ducts: current therapeutic prospects. G Chir, 2006,27:401-4.
[5] Nakao A, Fujii T, Sugimoto H, et al. Oncological problems in pancreatic cancer surgery. World J Gastroenterol, 2006,12:4466-72.
[6] Qian XJ, Zhai RY, Dai DK, et al. Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment. World J Gastroenterol, 2006,12:331-5.
[7] Adhoute X, Smith D, Vendrely V, et al. Subsequent resection of locally advanced pancreatic carcinoma after chemoradiotherapy. Gastroenterol Clin Biol, 2006,30:224-30.
[8] Saif MW. Pancreatic cancer: highlights from the 42nd annual meeting of the American Society of Clinical Oncology, 2006. JOP, 2006,7:337-48.
[9] Wilkowski R, Thoma M, Bruns C, et al. Chemoradiotherapy with gemcitabine and continuous 5-FU in patients with primary inoperable pancreatic cancer. JOP, 2006,7:349-60.
[10] Xie DR, Liang HL, Wang Y, et al. Meta-analysis on inoperable pancreatic cancer: a comparison between gemcitabine-based combination therapy and gemcitabine alone. World J Gastroenterol, 2006,12:6973-81.
[11] Okusaka T, Ishii H, Funakoshi A, et al. A phase I/II study of combination chemotherapy with gemcitabine and 5-fluorouracil for advanced pancreatic cancer. Jpn J Clin Oncol, 2006,36:557-63.
[12] Bachet JB, Mitry E, Lepere C, et al. Chemotherapy as initial treatment of locally advanced unresectable pancreatic cancer: a valid option?. Gastroenterol Clin Biol, 2007,31:151-6.
[13] Chang Q, Qin R, Huang T, et al. Effect of antisense hypoxia-inducible factor 1alpha on progression, metastasis, and chemosensitivity of pancreatic cancer. Pancreas, 2006,32:297-305.
[14] Yekebas EF, Bogoevski D, Bubenheim M, et al. Strong prognostic value of nodal and bone marrow micro-involvement in patients with pancreatic ductal carcinoma receiving no adjuvant chemotherapy. World J Gastroenterol, 2006,12:6515-21.
[15] Garofalo MC, Regine WF, Tan MT. On statistical reanalysis, the EORTC trial is a positive trial for adjuvant chemoradiation in pancreatic cancer. Ann Surg, 2006,244:332-3; author reply 333.
[16] Tsujie M, Nakamori S, Tanaka E, et al. Phase I/II trial of hyperfractionated accelerated chemoradiotherapy for unresectable advanced pancreatic cancer. Jpn J Clin Oncol, 2006,36:504-10.
[17] Boz G, De Paoli A, Innocente R, et al. Radiotherapy and chemotherapy in pancreatic cancer. Topical issues and future perspectives. JOP, 2006,7:122-30.
[18] Kim R, Saif MW_ Is there an Optimal Neoadjuvant Therapy for Locally Advanced Pancreatic Cancer_ JOP_ J Pancreas (Online) 2007; 8(3)279-288_ [Full text].
[19] Cardenes HR, Chiorean EG, Dewitt J, et al. Locally advanced pancreatic cancer:current therapeutic approach. Oncologist, 2006,11:612-23.
[20] Thomson BN, Banting SW, Gibbs P. Pancreatic cancer - current management. Aust Fam Physician, 2006,35:212-7.
[21]倪泉兴,傅德良。胰腺癌的介入治疗及临床评价。中国实用外科杂志2003:23(12)713-715
[22]郑家平,叶强,顾伟中。胰腺癌的血管介入治疗。介入放射学杂志2004:13(14)373-375
[23] Wilkowski R, Thoma M, Bruns C, et al. Combined chemoradiotherapy for isolated local recurrence after primary resection of pancreatic cancer. JOP, 2006,7:34-40.
[24] Saif MW, Moody JS, Russo SM. Gastrointestinal bleeding associated with concurrent capecitabine and radiotherapy in patients with pancreatic cancer. JOP, 2005,6:325-33.
[25] Wilkowski R, Thoma M, Weingandt H, et al. Chemoradiation for ductal pancreatic carcinoma: principles of combining chemotherapy with radiation, definition of target volume and radiation dose. JOP, 2005,6:216-30.
[26] Willett CG, Del Castillo CF, Shih HA, et al. Long-term results of intraoperative electron beam irradiation (IOERT) for patients with unresectable pancreatic cancer. Ann Surg, 2005,241:295-9.
[27]王俊杰,白静,修典荣,等。放射性125I粒子组织间植入治疗胰腺癌的疗效。中华普通外科杂志2004:19(8)512-514
[28]金震东,李兆申,刘岩,等。超声内镜引导下定向植入放射性125I粒子治疗胰腺癌的临床研究.。中华消化内镜杂志2006:23(1)15-18
[29]李欣,修典荣,王俊杰,等。放射介入、姑息手术以及姑息手术联合～125I粒子植入治疗晚期胰腺癌临床疗效比较.中国微创外科杂志2006:6(4)287-289
[30]李力军,封国生,刘璐,等。125I籽源与缓释化疗粒子联合植入靶向治疗进展期胰腺癌。东南大学学报2004:23(4)246-249
[31] El-Metwally TH, Pour PM. The retinoid induced pancreatic cancer redifferentiation apoptosis sequence and the mitochondria: a suggested obligatory sequence of events. JOP JT - JOP : Journal of the pancreas, 2007,8:268-78.
[32]杨国凯,罗开元,杨镛,等。125I粒子永久性植入组织间治疗胰腺癌的临床报告.临床外科杂志2003:11(2)92-95
[33]周伟,钟毓斌,洛小林,等。术中125I粒子植入与高能电子线放射治疗晚期胰腺癌的比较。中日友好医院学报2005:19(4)218-222
[34] Liu S, Wang XP, Brunicardi FC. Enhanced cytotoxicity of RIPTK gene therapy ofpancreatic cancer via PDX-1 co-delivery. J Surg Res, 2007,137:1-9.
[35] Tsuda N, Ishiyama S, Li Y, et al. Synthetic microRNA designed to target glioma-associated antigen 1 transcription factor inhibits division and induces late apoptosis in pancreatic tumor cells. Clin Cancer Res, 2006,12:6557-64.
[36] Eisold S, Antolovic D, Schmidt J, et al. Effective antitumoral immune responses are not induced by cytosine deaminase suicide gene transfer in a syngeneic rat pancreatic carcinoma model. Eur Surg Res, 2006,38:513-21.
[37] Freelove R, Walling AD. Pancreatic cancer: diagnosis and management. Am Fam Physician, 2006,73:485-92.
[38] Huch M, Abate-Daga D, Roig JM, et al. Targeting the CYP2B 1/cyclophosphamide suicide system to fibroblast growth factor receptors results in a potent antitumoral response in pancreatic cancer models. Hum Gene Ther, 2006,17:1187-200.
[39] Lu Y, Bai JG, Wang HH. Gene therapeutic treatment of pancreatic cancer based on injection of pcDNA3.1/CCK plasmid with xenogeneic homologous cholecystokinin. Exp Oncol, 2006,28:136-40.
[40] Kunisaki R, Ikawa S, Maeda T, et al. p51/p63, a novel p53 homologue, potentiates p53 activity and is a human cancer gene therapy candidate. J Gene Med, 2006,8:1121-30.
[41]王亚利,宋天宝,王西京等。SurvivinmRNA反义寡核苷酸诱导胰腺癌细胞凋亡。世界华人消化杂志2004:12(8)1872-1874
[42] Wang YF, Guo KJ, Huang BT, et al. Inhibitory effects of antisense phosphorothioate oligodeoxynucleotides on pancreatic cancer cell Bxpc-3 telomerase activity and cell growth in vitro. World J Gastroenterol, 2006,12:4004-8.
[43] Hara H, Kobayashi A, Yoshida K, et al. Local interferon-alpha gene therapy elicits systemic immunity in a syngeneic pancreatic cancer model in hamster. Cancer Sci, 2007,98:455-63.
[44] Cohenuram M, Saif MW_ Epidermal Growth Factor Receptor Inhibition Strategies in Pancreatic Cancer Past, Present and the Future_ JOP_ J Pancreas (Online) 2007; 8(1)4-15_ [Full text].
[45] Capello A, Krenning EP, Bernard BF, et al. Anticancer activity of targeted proapoptotic peptides. J Nucl Med, 2006,47:122-9.
[46] Yao JC. Neuroendocrine tumors. Molecular targeted therapy for carcinoid and islet-cell carcinoma. Best Pract Res Clin Endocrinol Metab, 2007,21:163-72.
[47] Krempien R, Muenter MW, Huber PE, et al. Randomized phase II--study evaluatingEGFR targeting therapy with cetuximab in combination with radiotherapy and chemotherapy for patients with locally advanced pancreatic cancer--PARC: study protocol [ISRCTN56652283]. BMC Cancer, 2005,5:131.
[48] Cohenuram M, Saif MW. Epidermal growth factor receptor inhibition strategies in pancreatic cancer: past, present and the future. JOP, 2007,8:4-15.
[49]李俊生,汤文浩。ZD1839对胰腺癌细胞的生长抑制作用及机理。肝胆外科杂志2007:15(1)59-62
[50]张波,赵玉沛,刘卫平等。光动力治疗裸鼠胰腺癌及其机理的实验研究.中国普外基础与临床杂志2003:10(1)30-33
[51]章明,白向君,李伟兵等。高强度聚焦超声治疗晚期胰腺癌,实用肿瘤学杂志,2004:14(4)126-129
[52] Polymeric nanoparticle-encapsulated curcumin (nanocurcumin) a novel strategy for human cancer therapy.
[53] Fazal S, Saif MW. Supportive and palliative care of pancreatic cancer. JOP, 2007,8:240-53.
[54] Brasiuniene B, Brasiunas V, Juozaityte E. [Effect of combined treatment methods on quality of life in patients with pancreatic cancer]. Medicina (Kaunas), 2006,42:817-22.
[55] Lohr JM. Medical treatment of pancreatic cancer. Expert Rev Anticancer Ther, 2007,7:533-44.
[56]刘瑞林,徐云,徐祗永等.姑息性综合治疗晚期胰腺癌39例临床观察.胃肠病学和肝病学杂志2005:14(3)306-309
[57] Peron JM, Bureau C, Gourdy P, et al. Treatment of experimental murine pancreatic peritoneal carcinomatosis with fibroblasts genetically modified to express IL12: a role for peritoneal innate immunity. Gut, 2007,56:107-14.
[58]孙燕.胰腺癌内科治疗和综合治疗.癌症进展杂志2004:2(9)367-369
[59] Brasiuniene B, Juozaityte E, Barauskas G. Impact of different treatment methods on survival in advanced pancreatic cancer. Medicina (Kaunas), 2005,41:382-5.