Okabayashi Takehiro, Kobayashi Michiya, Nishimori Isao, Namikawa Tsutomu, Okamoto Ken, Onishi Saburo, Araki Keijiro
Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku, 783-8505, Japan.
J Gastroenterol. 2005 Feb;40(2):192-9. doi: 10.1007/s00535-004-1520-9.
We analyzed the clinicopathologic variables and postoperative outcomes in patients with extrahepatic adenosquamous carcinoma to identify important factors for predicting postresection prognosis.
Thirty-six patients in Japan who underwent surgical resection for adenosquamous carcinoma of the extrahepatic biliary tract, with curative intent by the end of 2003, were studied. A retrospective review, with univariate and multivariate analyses, was performed on the clinical records of patients who underwent surgical exploration for adenosquamous carcinoma of the common bile duct. The clinical and pathologic factors that influenced patient survival were analyzed.
The operative mortality rate in the patient cohort was 3%. The overall 1-, 3-, and 5-year survival rates were 57%, 26%, and 16%, respectively, and the median survival was 13 months. Univariate and multivariate analyses revealed that independent negative prognostic factors in resected specimens were: (1) the presence of pancreatic invasion, (2) the presence of n2 and n3 lymph node metastasis, and (3) curability C status. The presence of an abnormal arrangement of the pancreatobiliary ductal system and pathological serosal invasion of the tumor tended to be associated with poor survival.
Curative surgical resection for adenosquamous carcinoma remains the only effective treatment, because it offers the chance of long-term survival. New adjuvant strategies are required for improvements in patient outcomes.
我们分析了肝外腺鳞癌患者的临床病理变量及术后结局，以确定预测切除术后预后的重要因素。
研究了2003年底前在日本接受手术切除肝外胆管腺鳞癌且有治愈意图的36例患者。对因胆总管腺鳞癌接受手术探查的患者临床记录进行回顾性研究，并进行单因素和多因素分析。分析影响患者生存的临床和病理因素。
患者队列中的手术死亡率为3%。总体1年、3年和5年生存率分别为57%、26%和16%，中位生存期为13个月。单因素和多因素分析显示，切除标本中的独立负性预后因素为：（1）存在胰腺侵犯；（2）存在N2和N3淋巴结转移；（3）治愈性C状态。胰胆管系统排列异常及肿瘤病理浆膜侵犯往往与生存不良相关。
腺鳞癌的根治性手术切除仍然是唯一有效的治疗方法，因为它提供了长期生存的机会。需要新的辅助策略来改善患者结局。
