Clinical Analysis Of 93 Cases With Pancreatic Carcinoma

Background and ObjectiveWith the development of medicine,early diagnosis of pancreatic carcinoma has much progressed,but the mortality of pancreatic carcinoma is still high,survival and prognosis are both not significantly improved,the reason may be that there are many deficiencies and limitations in current status of the diagnosis of pancreatic carcinoma,new technologies and methods can not be applied in clinical very well.In this paper,through the retrospective analysis of clinical manifestations,serum tumor markers,imaging and endoscopic methods of the patients with the discharge diagnosis of pancreatic carcinoma during January-December in 2008 in the second affiliated hospital,medical college of Zhejiang university,we can know our current status of pancreatic carcinoma diagnosis,which will be the evidence for further efforts.Research methodsThe clinical data of the patients with the discharge diagnosis of pancreatic carcinoma was collected during January-December in 2008 in the second affiliated hospital,medical college of Zhejiang university,including age,sex,clinical manifestations,the first symptoms,serum tumor markers(CA199,CA242,CEA),imaging examinations(B-US,CT,MRCP),endoscopic findings(ERCP,EUS),pathological findings, treatment,tumor site,et al.Then the clinical data was collated in accordance with the diagnosis standard,staging standard,in/ex-clusion standard of the pancreatic carcinoma, and was statistical analyzed finally.Research results①93 cases with pancreatic carcinoma are confirmed in the study.In the 93 cases with pancreatic carcinoma,there are 51 cases of male and 42 cases of female,with male to female ratio of approximately 1.2:1;these patients are distributed in 15～86 years old, with an average age of 62.35±8.71 years old,mainly in 50～70 years old,the number of patients under 50 years old accounted for 8.6%,the number of patients over 50 years old accountes for 91.4%;with 60-year-old as a cut-off point,in the patients under 60-year-old,the number of the female accountes for the majority(54.3%),especially in 40～50 years old(66.7%),on the contrary,in the patients over 60-year-old,the number of the male accountes for the majority(60.3%).②The distribution of number and proportion:followed by 6(6.45%),12(12.90%), 21(22.58%) and 54(58.06%) in stageⅠ,Ⅱ,ⅢandⅣ,more than 80%of patients are in advanced pancreatic carcinoma when diagnosed.③The clinical symptoms include weight loss(76.3%),abdominal pain(66.7%), jaundice(51.6%),anepithymia(48.4%),abdominal discomfort(45.2%),abdominal distention(43.0%),fatigue(38.7%),back pain(18.3%),diarrhea(14.0%) and melena(7.5%).Weight lost is the most common symptom,furthermore,jaundice is mostly seen in 67.3%patients with pancreatic head carcinoma,abdominal pain is mostly seen in 80.0%of patients with carcinoma in pancreatic body and tail;The first symptoms include abdominal pain(38.7%),jaundice(17.2%),abdominal distention(12.9%),epigastric discomfort(9.7%),anepithymia(8.6%),weight loss(5.4%), back pain(4.3%),fatigue(2.2%),diarrhea(1.1%):abdominal pain and jaundice are the most common first symptoms,but there are many other clinical symptoms appearing before abdominal pain and(or) jaundice,such as epigastric discomfort(19.3%), abdominal distension(17.7%),anepithymia(10.3%),fatigue(9%). ④In stageⅠ,Ⅱ,the main symptoms are epigastric discomfort(88.9%), anepithymia(72.2%),abdominal distension(55.6%),fatigue(50.0%).In stageⅢ,Ⅳ,the main symptoms are weight loss(94.7%),abdominal pain(82.7%),jaundice(64.0%);the proportion of epigastric discomfort and anepithymia in stageⅠ,Ⅱis higher than in stageⅢ,Ⅳ(P＜0.05).⑤In this group of patients with pancreatic carcinoma,the positive rate of CA19-9, CA242,CEA,CA19-9+CA242,CA19-9+CEA,CA242+CEA,CA19-9+CA242+CEA is followed by 82.2%(74/90),55.7%(34/61),33.3%(26/78),85.2%(52/61),83.3% (65/78),63.3%(38/60),88.3%(53/60).Among CA19-9,CA242,CEA,the positive rate of CA19-9 is highest;the positive rate of CA19-9+CA242,CA19-9+ CEA, CA19-9+CA242+CEA is no significant difference with the positive rate of CA19-9(P＞0.05).This shows that CA19-9 is still the most meaningful for the diagnosis of pancreatic carcinoma among traditional traditional serum tumor markers.⑥The titer value and positive rate of CEA and CA242 in stageⅣare both higher than in stageⅠ,Ⅱ,Ⅲ(P＜0.05);the titer value and positive rate of CA19-9 in stageⅡ,Ⅲ,Ⅳare both higher than in stageⅠ(P＜0.05);but the titer value and positive rate of CA19-9,CEA and CA242 are both not related with tumor site(P＞0.05).⑦The positive rate of CA19-9 in patients with distant metastasis is 96.3%,significantly higher than that in patients without distant metastasis(P＜0.05);the positive rate of CA19-9 in patients with radical operation is 89.2%,significantly higher than that in patients with non-radical operation(P＜0.01);the positive rate of CA19-9 and lymph node metastasis is no significant correlation(P＞0.05).⑧In this group of patients with pancreatic carcinoma,B-ultrasound,CT,MRCP, ERCP,EUS is applied in 86,89,24,7,2 cases respectively,the diagnostic accuracy is 72.94%,94.38%,100%,85.7%,100%respectively;6 cases are misdiagnosed in B-ultrasound examination,the misdiagnosis rate is 7.06%,13 cases are missed diagnosed,the rate of missed diagnosis is 15.29%,one case is misdiagnosed in CT examination,the misdiagnosis rate is 1.12%.⑨In stageⅠof pancreatic carcinoma,the diagnostic accuracy of B-ultrasound is 66.7%, significantly lower than in stageⅡ,ⅢandⅣ(P＜0.05);the diagnostic accuracies of CT are more than 80%in stages of pancreatic carcinoma;ERCP and EUS are rarely applied in this group of patients with pancreatic carcinoma,so it is difficult to compare the accuracy statistically.The diagnostic accuracies of B-US,CT,MRCP,ERCP,EUS in different tumor sites are not significantly different(P＞0.05).⑩The therapeutics used in the 93 cases with pancreatic carcinoma are radical operation(26.88%),palliative operation(22.58%),laparotomy(9.68%) and others(40.86%):high-intensity focused ultrasound(4.3%),interventional chemotherapy(1.08%),chemotherapy(2.15%),integrated treatment(4.30%), conservative medical treatment(29.03%);the radical operation rate in patients with pancreatic head carcinoma is 36.7%,significantly higher than pancreatic carcinoma in body,tail and whole pancreas(16.3%).Conclusion①Weight loss,abdominal pain,jaundice are the most common and non-specific clinical manifestations in patients with pancreatic carcinoma;early symptoms are insidious mostly,in StageⅠ,Ⅱ,the main symptoms were epigastric discomfort,anepithymia, abdominal distension,fatigue,especially the proportion of epigastric discomfort and anepithymia is higher than in StageⅢ,Ⅳ.②At present,among the traditional serum tumor markers of pancreatic carcinoma, CA19-9 is the most meaningful,with high positive rate(82.2%),especially in advanced pancreatic carcinoma patients with distant metastasis,the positive rate of CA19-9 is higher.But the value for early diagnosis is limited,and the positive rate of CA19-9,CA242 and CEA combined detection does not improve.③At present,among the conventional imaging methods,the diagnostic accuracy of B-US is low,only 72.94%,especially in stageⅠ,the diagnostic accuracy is only 66.7%, significantly lower than in stageⅡ,ⅢandⅣ.And with high rates of misdiagnosis and missed diagnosis.So B-US have limitations in early diagnosis of pancreatic carcinoma, but the diagnostic accuracies of CT and MRCP are both high,the diagnostic accuracies of CT are more than 80%in stages of pancreatic carcinoma,high selectivity imaging and endoscopic methods have not been applied in our hospital routinely.