Henson Donald Earl, Schwartz Arnold M, Nsouli Hala, Albores-Saavedra Jorge
George Washington University Cancer Institute, Washington, DC 20037, USA.
Arch Pathol Lab Med. 2009 Jan;133(1):67-71. doi: 10.5858/133.1.67.
Carcinomas co-occur in the pancreas, extrahepatic bile ducts, and ampulla of Vater. We investigated whether cancers originating in these sites represent a field effect similar to that observed in the lung and upper aerodigestive tract.
To determine whether a field effect for carcinogenesis exists in the ampulla of Vater, extrahepatic bile ducts, gallbladder, and pancreas.
Data were obtained from National Cancer Institute's Surveillance Epidemiology and End Results Program from 1973 through 2005. Cases were compared by age frequency density plots, age-specific incidence rates, and logarithmic plots of the age-specific incidence rates and age of diagnosis.
Incidence rates were 11.71, 1.43, 0.88, and 0.49 per 100,000 persons at risk for pancreatic, gallbladder, extrahepatic bile ducts, and ampullary carcinomas, respectively. Age frequency density plots were congruent for cancers originating in all 4 sites. Logarithmic plots of the age-specific incidence rates with age of diagnosis produced parallel linear rate patterns for the 4 sites indicative of similar populations for tumor development. However, density and logarithmic plots of pancreatic endocrine carcinomas, a tumor of different cellular differentiation and carcinogenic pathway, served as a comparison. The endocrine carcinomas showed a different age distribution and nonparallel rate patterns with ductal carcinomas.
Carcinomas of the pancreas, gallbladder, extrahepatic bile ducts, and ampulla have a common embryonic cellular ancestry, differentiation pathways, mucosal histologic patterns, and population-related tumor development indicating a field effect in carcinogenesis. Parallel linear rate patterns indicate (1) the rate of cancer development is similar in all 4 sites even though the absolute incidence rates vary and (2) regardless of location, the ductal epithelium is equally susceptible to malignant transformation. If carcinogenic pathways to cancer are similar, then the different incidence rates seen clinically may depend on the relative surface area of the ductal system in these sites. Pancreatic cancers are most common because the surface area of the pancreas' ductal system is greater than that of the gallbladder, extrahepatic bile ducts, and ampulla.
胰腺癌、肝外胆管癌和 Vater 壶腹癌常同时发生。我们研究了起源于这些部位的癌症是否代表一种与在肺和上呼吸道观察到的类似的场效应。
确定在 Vater 壶腹、肝外胆管、胆囊和胰腺中是否存在致癌的场效应。
数据来自美国国立癌症研究所1973年至2005年的监测、流行病学和最终结果计划。通过年龄频率密度图、年龄特异性发病率以及年龄特异性发病率与诊断年龄的对数图对病例进行比较。
胰腺癌、胆囊癌、肝外胆管癌和壶腹癌的发病率分别为每10万人中有11.71例、1.43例、0.88例和0.49例。起源于所有4个部位的癌症的年龄频率密度图是一致的。年龄特异性发病率与诊断年龄的对数图显示，这4个部位呈现平行的线性发病率模式，表明肿瘤发生的人群相似。然而，作为对照，绘制了胰腺内分泌癌（一种具有不同细胞分化和致癌途径的肿瘤）的密度图和对数图。内分泌癌显示出与导管癌不同的年龄分布和不平行的发病率模式。
胰腺癌、胆囊癌、肝外胆管癌和壶腹癌具有共同的胚胎细胞起源、分化途径、黏膜组织学模式以及与人群相关的肿瘤发生，表明存在致癌场效应。平行的线性发病率模式表明：（1）尽管绝对发病率不同，但所有4个部位的癌症发生速率相似；（2）无论位置如何，导管上皮同样易于发生恶性转化。如果致癌途径相似，那么临床上观察到的不同发病率可能取决于这些部位导管系统的相对表面积。胰腺癌最为常见，因为胰腺导管系统的表面积大于胆囊、肝外胆管和壶腹的表面积。
