Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
Clin Transl Oncol. 2012 May;14(5):391-5. doi: 10.1007/s12094-012-0814-2.
To analyse the outcome of adjuvant chemoradiotherapy for periampullary adenocarcinoma and the impact of tumour location as a prognosticator.
Between January 1991 and December 2002, 147 patients with periampullary cancer underwent adjuvant chemoradiotherapy after pancreaticoduodenectomy. Postoperative radiotherapy was delivered to tumour bed and regional lymph nodes up to 40 Gy at 2 Gy/fraction with a two-week planned rest. Intravenous 5-fluorouracil (500 mg/m(2)/day) was given on days 1-3 of each split course. The median follow-up period was 82 months in survivors.
Tumour >2 cm and margin-positivity were more common in patients with pancreatic cancer than nonpancreatic periampullary cancers (p<0.0001 and 0.0780, respectively). According to the tumour location, 5-year overall survival rates of ampulla of Vater, distal common bile duct, duodenal and pancreatic head cancers were 53.0%, 50.3%, 37.5%, and 13.0%, respectively (p<0.0001). On multivariate analysis, pancreatic location (p<0.0001) and nodal involvement (p=0.0123) were associated with inferior overall survival.
Regardless of its advanced histologic features, pancreatic location itself was an adverse prognostic factor affecting overall survival.
分析辅助放化疗治疗壶腹周围腺癌的疗效，以及肿瘤位置作为预后预测因子的影响。
1991 年 1 月至 2002 年 12 月，147 例壶腹周围癌患者在胰十二指肠切除术后接受辅助放化疗。术后放疗采用 2 Gy/次的分割剂量，共 40 Gy，2 周计划休息一次，照射肿瘤床和区域淋巴结。在每次分割疗程的第 1-3 天，给予静脉注射氟尿嘧啶（500mg/m2/天）。在幸存者中，中位随访时间为 82 个月。
与非胰周壶腹周围癌相比，胰腺癌患者的肿瘤>2cm 和切缘阳性更为常见（p<0.0001 和 0.0780）。根据肿瘤位置， Vater 壶腹、远端胆总管、十二指肠和胰头癌的 5 年总生存率分别为 53.0%、50.3%、37.5%和 13.0%（p<0.0001）。多因素分析显示，胰周位置（p<0.0001）和淋巴结受累（p=0.0123）与总生存不良相关。
无论其组织学特征如何，胰周位置本身就是影响总生存的不良预后因素。
