摘要目的：分析伴肝转移的胰腺导管腺癌（ PALM）患者接受姑息性治疗后影响预后的因素。方法回顾性分析天津医科大学肿瘤医院2001年1月至2015年12月间经病理确诊并仅接受姑息性治疗的108例PALM患者的临床特征、治疗方法及生存状况。采用Kaplan-Meier法计算生存率，采用单因素及多因素Cox比例风险回归模型分析影响患者生存时间的因素。结果108例患者中男性68例，女性40例，平均年龄58岁。患者本人或家属拒绝接受抗肿瘤治疗者77例（71．3％）。所采用的姑息治疗方法包括5例次（4．6％）在剖腹探查后行胆总管空肠吻合和（或）胃空肠吻合术，21例次（19．4％）行经皮肝穿刺胆道外引流术，79例次（73．1％）行药物镇痛治疗，17例次（15．7％）行药物联合腹腔神经阻滞术镇痛治疗。全组患者的中位生存期为94 d。患者功能状态（ KPS）评分＜80分、淋巴结转移、腹水、空腹血糖≥6．1 mmol／L、LDH≥250 U／L为影响PALM患者预后的独立危险因素。按患者同时有上述0～1、2～3、4～5个因素分为危险度低、中、高组，3组患者的中位生存时间分别为137、95、48 d，差异有统计学意义（P＜0．0001）。结论 KPS评分、淋巴结转移、腹水、空腹血糖和LDH水平是PALM患者预后的危险因素，据此进行危险度分组更有利于个体化的肿瘤预后判断，并可为临床决策提供参考。

abstractsObjectives To explore the prognostic factors of patients with pancreatic ductal adenocarcinoma and synchronous liver metastases ( PALM ) receiving palliative treatment .Methods The clinical characteristics , therapeutic approaches and survival outcomes of 108 consecutive patients with PALM who were pathologically diagnosed and received only palliative treatment at Tianjin Medical University Cancer Hospital from January 2001 to December 2015 .were retrospectively analyzed .Survival rates were calculated by Kaplan-Meier method, and factors influencing the survival were analyzed by univariate and multivariate Cox proportional hazard regression model .Results Of these patients, 68 were male and 40 were female, with an average age of 58 years old.Seventy-seven (71.3%) cases or their relatives refused to receive anticancer therapies.Palliative treatments included choledochojejunostomy and /or gastrojejunostomy after exploratory laparotomy for 5 (4.6%) cases, percutaneous transhepatic biliary drainage (n=22, 19.4%), drug analgesia (n=79, 73.1%), drug analgesia combined with percutaneous neurolytic coeliac plexus block (n=17, 15.7%).The median survival time (MS)was 94 days in all patients.Karnofsky performance score (KPS)<80, lymph node metastases, ascites, fasting blood glucose ≥6.1 mmol/L and lactate dehydrogenase&nbsp;( LDH ) ≥250 U/L were independent risk factors influencing prognosis of PALM . Three groups were categorized according to the number of the above 5 risk factors for 0~1 in low risk group, 2~3 in middle risk group and 4~5 in high risk group, and the MS of 3 groups was 137, 95 and 48 days, respectively, with an extremely statistical significance (P<0.0001).Conclusions KPS, lymph node metastases, ascites, fasting blood glucose and LDH were the risk factors for prognosis of PALM .Patient stratification according to the above factors is more advantageous for judging individualized prognosis and can provide reference for making clinical decision .