Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Surg Oncol. 2012 Mar;105(3):266-72. doi: 10.1002/jso.22090. Epub 2011 Aug 31.
Ampullary cancer is considered to have a better prognosis than cancers of the distal bile duct and pancreas, and recent publications emphasize the prognostic importance of the histologic differentiation of the intestinal and pancreatobiliary types of ampullary cancer. The aims of this study were to identify those factors that affect recurrence after curative resection and to investigate differences between the clinicopathologic features of these two pathologic subtypes.
The medical records of patients that underwent pancreatoduodenectomy for ampullary carcinoma from February 1995 to March 2009 at our institute were retrospectively reviewed. One hundred and four patients that underwent curative resection for ampullary carcinoma were enrolled in this study. One pathologist reviewed all pathologic reports and histopathologic findings. Data on clinicopathologic factors and disease free and overall survival were analyzed.
The 3- and 5-year disease free survival rates of the 104 study subjects were 62.2% and 57.7%, respectively, and overall survival rates were 69.4% and 60.1%, respectively. Multivariate analysis showed that an advanced T stage (P = 0.049), the presence of lymph node metastasis (P = 0.003), poor differentiation (P = 0.039), and the pancreatobiliary type (P = 0.022) significantly increased the risk of recurrence. Furthermore, the pancreatobiliary type was found to be more associated with an advanced T stage (P = 0.009), regional lymph node metastasis (P = 0.007), and perineural invasion (P = 0.026) than the intestinal type. In addition, pathologic subtype analysis showed that Carcinoembryonic antigen (CEA) level and lymph node metastasis were important predictors of recurrence in patients with the intestinal (P = 0.013) and pancreatobiliary types, respectively (P = 0.003).
An advanced T stage, nodal metastasis, poor differentiation, and the pancreaticobiliary type were found to be independent predictors of recurrence after curative resection of ampullary carcinoma by multivariate analysis. In addition, the pancreatobiliary type tended to present in a more advanced T stage and more frequently with regional lymph node involvement and perineural invasion than the intestinal type. Furthermore, CEA level and lymph node metastasis were found to be independent predictors of recurrence for the intestinal and pancreatobiliary types, respectively.
相较于远端胆管癌和胰腺癌，壶腹癌的预后更好，近期出版物强调了肠型和胰胆型壶腹癌的组织学分化对预后的重要性。本研究旨在确定影响根治性切除术后复发的因素，并研究这两种病理亚型的临床病理特征差异。
回顾性分析我院自 1995 年 2 月至 2009 年 3 月期间因壶腹癌行胰十二指肠切除术的患者的病历。本研究纳入了 104 例接受根治性切除的壶腹癌患者。由一位病理学家对所有病理报告和组织病理学发现进行了审核。分析了临床病理因素、无病生存期和总生存期的数据。
104 例研究对象的 3 年和 5 年无病生存率分别为 62.2%和 57.7%，总生存率分别为 69.4%和 60.1%。多因素分析显示，T 期较晚（P=0.049）、存在淋巴结转移（P=0.003）、分化差（P=0.039）和胰胆型（P=0.022）显著增加了复发风险。此外，与肠型相比，胰胆型与 T 期较晚（P=0.009）、区域淋巴结转移（P=0.007）和神经周围侵犯（P=0.026）更为相关。此外，病理亚型分析显示，CEA 水平和淋巴结转移是肠型（P=0.013）和胰胆型（P=0.003）患者复发的重要预测因素。
多因素分析显示，T 期较晚、淋巴结转移、分化差和胰胆型是根治性切除术后壶腹癌复发的独立预测因素。此外，与肠型相比，胰胆型更倾向于表现为更晚期的 T 期，并更常伴有区域淋巴结受累和神经周围侵犯。此外，CEA 水平和淋巴结转移分别是肠型和胰胆型复发的独立预测因素。
