Pancreatic cancer (PDAC) has a poor prognosis despite surgical removal and adjuvant therapy. Additionally, the effects of postoperative analgesia with morphine and piritramide on survival among PDAC patients are unknown, as are their interactions with opioid/cannabinoid receptor gene expressions in PDAC tissue. Cancer-specific survival data for 71 PDAC patients who underwent radical surgery followed by postoperative analgesia with morphine (n= 48) or piritramide (n= 23) were therefore analyzed in conjunction with opioid/cannabinoid receptor gene expressions in the patients’ tumors. Receptor gene expressions were determined using the quantitative real-time polymerase chain reaction. Patients receiving morphine had significantly longer cancer-specific survival (CSS) than those receiving piritramide postoperative analgesia (median 22.4 vs. 15 months;p= 0.038). This finding was supported by multivariate modelling (p< 0.001). The morphine and piritramide groups had similar morphine equipotent doses, receptor expression, and baseline characteristics. The opioid/cannabinoid receptor gene expression was analyzed in a group of 130 pancreatic cancer patients. Of the studied receptors, high cannabinoid receptor 2 (CB2) and opioid growth factor receptor (OGFR) gene expressions have a positive influence on the length of overall survival (OS;p= 0.029, resp.p= 0.01). Conversely, high delta opioid receptor gene expression shortened OS (p= 0.043). Multivariate modelling indicated that high CB2 and OGFR expression improved OS (HR = 0.538,p= 0.011, resp. HR = 0.435,p= 0.001), while high OPRD receptor expression shortened OS (HR = 2.264,p= 0.002). Morphine analgesia, CB2, and OGFR cancer tissue gene expression thus improved CSS resp. OS after radical PDAC surgery, whereas delta opioid receptor expression shortened OS.
胰腺癌（PDAC）患者即使接受手术切除和辅助治疗，预后仍然较差。此外，术后使用吗啡和哌腈米特进行镇痛对PDAC患者生存期的影响尚不明确，这些药物与PDAC组织中阿片类/大麻素受体基因表达的相互作用也属未知。为此，本研究对71例接受根治性手术后使用吗啡（48例）或哌腈米特（23例）进行术后镇痛的PDAC患者的癌症特异性生存数据进行了分析，并结合了患者肿瘤组织中阿片类/大麻素受体基因的表达情况。受体基因表达通过实时定量聚合酶链反应测定。结果显示，接受吗啡镇痛的患者其癌症特异性生存期显著长于接受哌腈米特镇痛的患者（中位生存期22.4个月 vs. 15个月；p=0.038）。多变量模型分析进一步支持了这一发现（p<0.001）。两组患者在吗啡等效剂量、受体表达及基线特征方面均相似。此外，研究还对130例胰腺癌患者的阿片类/大麻素受体基因表达进行了分析。在所研究的受体中，高表达的大麻素受体2（CB2）和阿片生长因子受体（OGFR）基因对总生存期有积极影响（分别为p=0.029和p=0.01）。相反，高表达的δ阿片受体会缩短总生存期（p=0.043）。多变量模型表明，高CB2和OGFR表达可改善总生存期（风险比分别为HR=0.538，p=0.011和HR=0.435，p=0.001），而高OPRD受体表达则会缩短总生存期（HR=2.264，p=0.002）。因此，在PDAC根治术后，吗啡镇痛以及癌组织中CB2和OGFR基因的高表达可改善癌症特异性生存期和总生存期，而δ阿片受体高表达则会缩短总生存期。
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