胰十二指肠癌：304例患者的临床病理研究及癌胚抗原和糖类抗原19-9的免疫组化观察

Pancreatoduodenal carcinoma: a clinicopathologic study of 304 patients and immunohistochemical observation for CEA and CA19-9.

作者信息

Yamaguchi K, Enjoji M, Tsuneyoshi M

机构信息

Second Department of Pathology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

出版信息

J Surg Oncol. 1991 Jul;47(3):148-54. doi: 10.1002/jso.2930470303.

DOI:10.1002/jso.2930470303

PMID:2072697

Abstract

A total of 304 patients with pancreatoduodenal carcinoma were studied clinicopathologically and immunohistochemically in order to clarify features of carcinoma of four different sites of origin; carcinoma of the ampulla of Vater (Am), the distal common bile duct (DCBD), the head of the pancreas (PH), and the extra-ampullary duodenum (Du). The mean greatest diameter of 87 PH was 3.5 cm compared with 2.7 cm of 149 Am and 2.7 cm of DCBD. Histopathologically, 40% of Am were papillary adenocarcinoma, while about half of DCBD, PH and Du were tubular adenocarcinoma. PH invaded lymphatic (85%), vascular (62%), and perineural (95%) spaces and metastasized lymph nodes (72%) more frequently than Am (77%, 35%, 24%, 50%), DCBD (47%, 61%, 65%, 45%), and Du (76%, 29%, 35%, 65%), respectively. More than 50% of PH invaded the resected margins, whereas in only 2% of Am, the surgical margins were affected by malignant cells. Immunohistochemically, PH was more frequently positive for both carcinoembryonic antigen (CEA) (98%) and carbohydrate antigen (CA) 19-9 (91%) than Am (83%, 62%), DCBD (94%, 58%), and Du (56%, 11%), respectively. The stromal staining type of CEA and CA 19-9 was more frequently seen in PH (27%, 44%) than in Am (9%, 31%), DCBD (11%, 8%) and Du (0%, 0%), showing a more dedifferentiated nature of PH. The cumulative 3-year survival rate of 87 patients with PH (15%) was worse than that of 149 with Am (42%, P less than 0.001), of 51 with DCBD (25%) and of 17 with Du (58%, P less than 0.001). The survival curve of 87 with PH was worse than that of 51 with DCBD, of 149 with Am (P less than 0.001) and of 17 with Du (P less than 0.001). Cox regression analysis, using eleven profound prognostic variables, revealed that venous invasion, perineural infiltration, surgical margin, and histopathologic type were profound prognostic factors. Pancreatic carcinoma has a more dedifferentiated histopathologic nature, showing a more aggressive growth and fares worse than Am, DCBD, and Du.

摘要

为明确四种不同起源部位的癌的特征，对304例胰十二指肠癌患者进行了临床病理和免疫组化研究，这四种起源部位分别为：Vater壶腹癌（Am）、胆总管远端癌（DCBD）、胰头癌（PH）和壶腹外十二指肠癌（Du）。87例PH的平均最大直径为3.5 cm，而149例Am和DCBD的平均最大直径为2.7 cm。组织病理学上，40%的Am为乳头状腺癌，而DCBD、PH和Du约一半为管状腺癌。与Am（77%、35%、24%、50%）、DCBD（47%、61%、65%、45%）和Du（76%、29%、35%、65%）相比，PH更易侵犯淋巴管（85%）、血管（62%）和神经周围间隙（95%），且更易发生淋巴结转移（72%）。超过50%的PH侵犯切除边缘，而只有2%的Am手术边缘有癌细胞浸润。免疫组化方面，PH癌胚抗原（CEA）（98%）和糖类抗原（CA）19-9（91%）的阳性率分别高于Am（83%、62%）、DCBD（94%、58%）和Du（56%、11%）。PH中CEA和CA 19-9的间质染色类型（27%、44%）比Am（9%、31%）、DCBD（11%、8%）和Du（0%、0%）更常见，表明PH具有更高的去分化性质。87例PH患者的3年累积生存率（15%）低于149例Am患者（42%，P<0.001）、51例DCBD患者（25%）和17例Du患者（58%，P<0.001）。87例PH患者的生存曲线比51例DCBD患者、149例Am患者（P<0.001）和17例Du患者（P<0.001）更差。Cox回归分析使用11个深度预后变量，结果显示静脉侵犯、神经周围浸润、手术边缘和组织病理学类型是深度预后因素。胰腺癌具有更高的去分化组织病理学性质，生长更具侵袭性，预后比Am、DCBD和Du更差。