| Objective:To observe the survival prognosis of patients with unresectable advanced pancreatic cancer,analyze the prognostic factors,and do the further analysis combined with syndromes to explore the dominant population.Methods:The clinical data of patients with advanced pancreatic cancer who did not receive radical surgery were collected in the outpatient department of Zhang Peitong in the Oncology Department of Guang 'anmen Hospital from January 2018 to January 2021 and followed up by questionnaire or telephone.The study variables were age,gender,BMI,previous diabetes,smoking history,alcohol history,family history,pathogenic site,tumor length greater than 4.5 cm,the degree of differentiation,presence of cancer pain,presence of jaundice,presence of ascites,presence of liver metastasis,presence of lymph node metastasis,presence of blood vessels invasion,presence of multiple metastasis,presence of CEA positive,presence of CA199 positive,Presence of CA199>1000U/ml,palliative surgery,chemotherapy,multi-course chemotherapy,radiotherapy,immunotherapy,targeted therapy,and intervention time of traditional Chinese medicine.Kaplan-Meier method was used to conduct survival time statistics,and draw survival curves.The results were tested by log-rank test,which were statistically significant at p<0.05.Factors in the univariate analysis of which p<0.1 and the factors recognized to have a direct impact on survival were included in Cox regression model for multivariate analysis,and the results were statistically significant at p<0.05.When the measurement data are normally distributed,the t-test method is used.Chi-square test was used to compare the distribution of syndrome in subgroupsResults:By the end of follow-up,102 advanced pancreatic cancer patients who conform to the inclusion and exclusion criteria were included in the study,and 2 patients were lost to follow-up.The follow-up rate is 98.04%.The overall mean survival time was 17.61 months and the median survival time was 15.17 months.The longest surviving time is 35.03 months.The 6-month,1-year,2-year and 3-year survival rates were 91.00%,64.20%,28.60%and 17.40%.The median survival time of ? period was 19.90 months and the median survival time of ? period was 15.10 months.Univariate analysis showed that diameter of tumor?4.5cm,jaundice,ascites,liver metastasis,CEA positive,CA199>1000U/ml,chemotherapy,multi-course chemotherapy,immunotherapy,traditional Chinese medicine intervention time were related factors affecting prognosis(P<0.05).Age,gender,BMI,previous diabetes,smoking history,alcohol history,family history,pathogenic site,degree of differentiation,cancer pain,lymph node metastasis,invasion of blood vessels,multiple metastasis,CA199 positive,palliative surgery,radiotherapy,targeted therapy had no significant relationship with prognosis(P>0.05).In multivariate analysis,cancer pain and jaundice were independent risk factors affecting the prognosis of advanced pancreatic cancer patients(P=0.016,P=0.018).TCM intervention for more than 6 months and TCM intervention for more than 12 months were independent protective factors affecting the prognosis of advanced pancreatic cancer patients(P=0.000,P=0.029).In terms of quality of life,symptoms of all patients decreased,pain relieved and KPS scores gradually increased within 1 to 3 months after admission.In the study of syndromes,73.53%of 102 advanced pancreatic cancer patients were mixed syndromes of deficiency and excess,including syndrome of liver stagnation and qi stagnation and spleen deficiency,syndrome of liver stagnation and spleen deficiency and blood stasis,syndrome of liver and gallbladder dampness and blood stasis,syndrome of spleen and stomach Yang deficiency and blood stasis,syndrome of spleen deficiency and dampness-heat connotation.26.47%was excess syndromes,which was the syndrome of dampness of liver and gall and blood stasis.In the jaundice group,the syndrome of dampness and blood stasis of liver and gallbladder was the main syndrome type,while in the non-jaundice group,the syndrome of blood stasis of liver stagnation and spleen deficiency and the syndrome of liver stagnation and qi stagnation and spleen deficiency accounted for the main proportion(P=0.001).There were no significant differences in the distribution of syndrome types in the degree of differentiation,tumor size,metastatic site,cancer pain and ascites group.Combined with the survival analysis,according to order of the median survival time from largest to smallest,there were liver stagnation and qi stagnation and spleen deficiency,dampness-heat accumulation of spleen deficiency,liver stagnation and spleen deficiency and blood stasis,liver and gall dampness and blood stasis,and spleen and stomach Yang deficiency and blood stasis(P=0.000).In the group of CEA positive,CA199>1000U/ml,ascites and TCM intervention for more than 12 months,there was no significant difference in survival time.In the group of tumor diameter?4.5cm,the prognosis of syndrome of dampness-heat accumulation with spleen deficiency was better,and the prognosis of syndrome of blood stasis with spleen and stomach Yang deficiency was the worst.In the jaundice group,the prognosis of the syndrome of dampness-heat of spleen deficiency was better,and the prognosis of the syndrome of dampness-heat of liver and gallbladder was relatively poor.In the liver metastasis group,the prognosis of the syndrome of liver stagnation and qi stagnation and spleen deficiency was better,while the prognosis of the syndrome of spleen and stomach Yang deficiency and blood stasis was worse.In the chemotherapy group,the prognosis of the syndrome of liver stagnation and qi stagnation and spleen deficiency was better,while the prognosis of the syndrome of spleen and stomach Yang deficiency and blood stasis was worse.The prognosis of the syndrome of liver stagnation,spleen deficiency and blood stasis was better in the multi-course chemotherapy group,while the prognosis of the syndrome of liver and gallbladder dampness and blood stasis was worse.The syndrome type with better prognosis was the syndrome of dampness-heat accumulation of spleen deficiency and the syndrome type with worse prognosis was the syndrome of Yang deficiency of spleen and stomach and blood stasis in the group with TCM intervention over 6 months.(P<0.05)Conclusion:In this study,it was found that in patients with advanced pancreatic cancer,tumor diameter?4.5cm,jaundice,ascites,liver metastasis,CEA positive,CA199>1000U/ml,chemotherapy,multi-course chemotherapy,immunotherapy and intervention time of TCM affect the survival and prognosis of patients.Cancer pain and jaundice were independent prognostic risk factors,while TCM intervention for more than 6 months and TCM intervention for more than 12 months were independent prognostic protective factors.Patients with middle and advanced pancreatic cancer are mainly characterized by deficiency and excess syndrome,including five main complex syndrome types:the liver stagnation and qi stagnation and spleen deficiency syndrome,the liver stagnation and spleen deficiency and blood stasis syndrome,the liver and gallbladder dampness and blood stasis syndrome,the spleen and stomach Yang deficiency and blood stasis syndrome,and the spleen deficiency and dampness-heat accumulation syndrome.The main syndrome type of jaundice was the liver and gallbladder dampness and blood stasis syndrome.In the group of tumor diameter?4.5cm,jaundice,liver metastasis,chemotherapy,multi-course chemotherapy,and TCM intervention for more than 6 months,the syndrome type with better prognosis was the syndrome of the liver stagnation and qi stagnation and spleen deficiency,the liver stagnation and spleen deficiency and blood stasis and the spleen deficiency and dampness-heat accumulation,while the syndrome type with worse prognosis was the syndrome of Yang deficiency of spleen and stomach and blood stasis and the liver and gallbladder dampness and blood stasis syndrome. |
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