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Clinical practice guidelines for the interventional treatment of advanced pancreatic carcinoma (on trial) (6th edition)
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TNM分期 内容 TNM分期 T分期 N分期 M分期 原发肿瘤(T) Tx：原发肿瘤无法评估
T0：无原发肿瘤证据
Tis：原位癌
T1: 肿瘤最大径≤2.0 cm
T1a：肿瘤最大径≤0.5 cm
T1b: 肿瘤最大径＞0.5 cm且＜1.0 cm
T1c：肿瘤最大径≥1.0 cm且≤2.0 cm
T2: 肿瘤最大径＞2.0 cm且≤4.0 cm
T3: 肿瘤最大径＞4.0 cm
T4: 肿瘤不论大小，累及腹腔干、
肠系膜上动脉，和/或肝总动脉0 Tis N0 M0 ⅠA T1 N0 M0 ⅠB T2 N0 M0 ⅡA T3 N0 M0 ⅡB T1~3 N1 M0 Ⅲ T4 Any N M0 Any T N2 M0 Ⅳ Any T Any N M1 区域淋巴结(N) Nx: 区域淋巴结无法评估
N0: 无区域淋巴结转移
N1: 1~3枚区域淋巴结转移
N2: 4枚以上区域淋巴结转移远处转移(M) M0: 无远处转移M1: 有远处转移 
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表 2 射频参量及相关参数
Table 2. RF parameters and related parameters
电极种类 数量 间距(mm) 目标能量(kJ) 功率设定(W) 治疗长度(mm) 治疗直径(mm) 治疗体积(cm3) T20 1 9 20 22 20 5 T20 2 7 14 40 25 20~27 7 T20 3 15 24 60 25 20~30 12 T30 1 15 30 32 22 5.5 T30 2 13 25 60 35 25 8 T30 3 15 15~35 90 35 20~30 14 T40 1 29 40 44 25 14 T40 2 13.3 39 80 45 25~33 19 T40 3 20 35~70 120 50 30~40 22 T40 3 25 70~130 120 55 40~50 47 T40 3 30 130~250 120 60 50~60 87
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表 3 微波能量及相关参数
Table 3. Microwave energy and related parameters
消融时间 主机功率 50 W 55 W 60 W 70 W 5 min 40×25×5 40×26×5 42×27×6 44×30×7 8 min 42×26×5 43×27×6 44×30×6 46×32×7 10 min 45×28×5 48×30×6 49×32×7 50×34×8 12 min 48×30×6 49×32×7 50×34×7 52×36×10 15 min 50×34×6 51×36×7 52×38×7 54×40×10
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表 4 晚期胰腺癌介入方法选择方案
Table 4. Selection of interventional methods for advanced pancreatic cancer
cTAI治疗 低/未分化腺癌、血供丰富、基因敏感ROBO3↑/miR-250b↓等 胰头部：胃十二指肠动脉、肠系膜上动脉 胰体尾部：脾短动脉、胃网膜右动脉 优势动脉：化疗栓塞；非优势动脉：栓塞 物理治疗 中/高分化腺癌、血供不丰富、基因不敏感ROBO3/miR-250b等 胰头部：125I粒子植入 体尾部：射频/微波消融
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表 5 三组晚期胰腺癌患者基本资料
Table 5. Basic data of three groups of patients with advanced pancreatic cancer
参数 对症治疗(n=406) 对症+介入(n=422) 对症+化疗(n=190) 统计值 P值 年龄(岁) 71.84±11.58 66.39±11.37 62.25±10.05 F=1.290 0.075 性别[例(%)] χ2=0.955 0.620 男 252(62.07) 255(60.43) 110(57.89) 女 154(37.93) 167(39.57) 80(42.11) TNM分期[例(%)] χ2=2.012 0.366 T3N1MO 55(13.55) 45(10.66) 20(10.53) T3N1M1 351(86.45) 377(89.34) 170(89.47) 肿瘤大小[例(%)] χ2=8.753 0.068 ＜3.0 cm 10(2.46) 9(2.13) 8(4.21) 3.0~5.0 cm 38(9.36) 50(11.85) 31(16.31) ＞5.0 cm 358(88.18) 363(86.02) 151(79.48) 有无转移[例(%)] χ2=0.075 0.963 有 345(84.98) 360(85.31) 152(80.00) 无 61(15.02) 62(14.69) 38(20.00) 腹腔积液[例(%)] χ2=25.823 0.000 有 80(19.70) 32(7.58) 28(14.74) 无 326(80.30) 390(92.42) 162(85.26) 黄疸[例(%)] χ2=83.009 0.000 有 122(30.05) 250(59.24) 110(57.89) 无 284(69.95) 172(40.76) 80(42.11) Child-Pugh分级[例(%)] χ2=72.295 0.000 A级 16(3.94) 8(1.90) 35(18.42) B级 94(23.15) 105(24.88) 48(25.26) C级 296(72.90) 309(73.22) 107(56.32) CA19-9[例(%)] χ2=3.355 0.187 正常 88(21.67) 105(24.88) 54(28.42) 异常 318(78.33) 317(75.12) 136(71.58)
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表 6 三组临床缓解率比较
Table 6. Comparison of clinical remission rates among the three groups
mRECIST 对症治疗(n=406) 对症+介入(n=422) 对症+化疗(n=190) 总计(n=1018) P值 完全缓解+部分缓解[例(%)] 80(19.7) 198(46.9) 79(41.6) 341(33.5) 0.000 疾病稳定[例(%)] 105(25.9) 147(34.8) 59(31.1) 418(41.1) 疾病进展[例(%)] 221(54.4) 77(18.2) 55(28.9) 259(25.4)
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表 7 三组间6、12、18个月生存率比较
Table 7. Comparison of 6, 12 and 18 month survival rates among the three groups
时间 结局 对症治疗(n=406) 对症+介入(n=422) 对症+化疗(n=190) 总计(n=1018) P值 6个月 0.000 存活[例(%)] 77(19.0) 341(80.8) 120(63.2) 538(52.8) 死亡[例(%)] 329(81.0) 81(19.2) 70(36.8) 480(47.2) 12个月 0.000 存活[例(%)] 8(2.0) 114(27.0) 42(22.1) 164(16.1) 死亡[例(%)] 398(98.0) 308(73.0) 148(77.9) 854(83.9) 18个月 0.000 存活[例(%)] 0 46(10.9) 15(7.9) 61(6.0) 死亡[例(%)] 406(100.0) 376(89.1) 175(92.1) 957(94.0)
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