多数胰腺癌病人的临床表现与胰腺癌在胰腺的位置相关。黄疸作为一种症状，多数表明胰腺癌的位置多在胰头、颈和沟突部。持续的腹疼或背疼往往是在黄疸出现之前的非特异性的前期感觉。糖尿病，胰腺炎，食欲减退，体重下降；胃出口阻塞和腹水往往出现在晚期[1]。左侧胰腺癌长期没有症状，直到4~5cm大小时可能出现症状[2]。 血栓栓塞性疾病包括周围静脉血栓，游走性血栓性静脉炎以及肺栓塞是常见的表现，发生率在17~57%[3]。肿瘤的位置，体力状态受损和凝血因子增加（如凝血酶，纤维蛋白原）和可以促进血栓形成的至炎因子增加（如转化生长因子）可以解释晚期病人出现血栓栓塞性疾病的高发[4]。其发生表明预后差。很多实验用于预防性抗凝治疗对晚期胰腺癌的影响（低分子肝素），没有证据表明可以降低血栓栓塞事件的减少和改善晚期患者对化疗的反应，从而提高患者的整体生存率[5,6]。但也有些预防性抗凝治疗正在进行中，以便更好的定义抗凝治疗在晚期胰腺癌患者中的作用[7]。 1. Royal, R. E., Wolff, R. A. & Crane, C. H. in Cancer Principles and Practice of Oncology (Eds De Vita Jr, V. T., Lawrence, T. & Rosenberg, S. A.) 8th edition, 1, 1118—1120 (Lippincott Williams and Wilkins, Philadelphia, USA, 2008). 2. Sohn, T. A. et al. Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J. Gastrointest. Surg. 4, 567—579 (2000). 3. Khorana, A. A. & Fine, R. L. Pancreatic cancer and thromboembolic disease. Lancet Oncol. 5, 655—663 (2004). 4. Sohail, M. A. & Saif, M. W. Role of anticoagulation in the management of pancreatic cancer. JOP 10, 82—87 (2009). 5. Icli, F. et al. Low molecular weight heparin (LMWH) increases the efficacy of cisplatinum plus gemcitabine combination in advanced pancreatic cancer. J. Surg. Oncol. 95, 507—512 (2007).
6. von Delius, S. et al. Effect of low-molecular weight heparin on survival in patients with advanced pancreatic adenocarcinoma. Thromb. Haemost.98, 434—439 (2007). 7. Riess, H. et al. Rational and design of PROSPECT-CONKO 004: a prospective, randomized trial of simultaneous pancreatic cancer treatment with enoxaparin and chemotherapy [abstract]. BMC Cancer 8, a361 (2008). |