I 期 Vater 壶腹腺癌的失败模式：单机构经验。
Patterns of failure for stage I ampulla of Vater adenocarcinoma: a single institutional experience.
机构信息
1 School of Medicine, Duke University, Durham, USA ; 2 Department of Radiation Oncology, 3 Department of Pathology, 4 Duke Cancer Institute, 5 Department of Surgery, 6 Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
出版信息
J Gastrointest Oncol. 2014 Dec;5(6):421-7. doi: 10.3978/j.issn.2078-6891.2014.084.
BACKGROUND
Ampullary adenocarcinoma is a rare malignancy associated with a relatively favorable prognosis. Given high survival rates in stage I patients reported in small series with surgery alone, adjuvant chemoradiotherapy (CRT) has traditionally been recommended only for patients with high risk disease. Recent population-based data have demonstrated inferior outcomes to previous series. We examined disease-related outcomes for stage I tumors treated with pancreaticoduodenectomy, with and without CRT.
METHODS
All patients with stage I ampullary adenocarcinoma treated from 1976 to 2011 at Duke University were reviewed. Disease-related endpoints including local control (LC), metastasis-free survival (MFS), disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method.
RESULTS
Forty-four patients were included in this study. Thirty-one patients underwent surgery alone, while 13 also received adjuvant CRT. Five-year LC, MFS, DFS and OS for patients treated with surgery only and surgery with CRT were 56% and 83% (P=0.13), 67% and 83% (P=0.31), 56% and 83% (P=0.13), and 53% and 68% (P=0.09), respectively.
CONCLUSIONS
The prognosis for patients diagnosed with stage I ampullary adenocarcinoma may not be as favorable as previously described. Our data suggests a possible benefit of adjuvant CRT delivery.
背景
壶腹腺癌是一种罕见的恶性肿瘤，其预后相对较好。由于小系列手术治疗的 I 期患者的生存率较高，传统上仅建议高危疾病患者接受辅助放化疗（CRT）。最近的基于人群的数据表明，其结果不如以前的系列。我们检查了接受胰十二指肠切除术治疗的 I 期肿瘤的与疾病相关的结果，包括 CRT 治疗和未治疗的患者。
方法
回顾了 1976 年至 2011 年期间在杜克大学接受治疗的所有 I 期壶腹腺癌患者。使用 Kaplan-Meier 方法分析与疾病相关的终点，包括局部控制（LC）、无转移生存（MFS）、无病生存（DFS）和总生存（OS）。
结果
本研究纳入了 44 例患者。31 例患者仅接受手术治疗，13 例患者还接受辅助 CRT。单独手术和手术加 CRT 治疗的患者的 5 年 LC、MFS、DFS 和 OS 分别为 56%和 83%（P=0.13）、67%和 83%（P=0.31）、56%和 83%（P=0.13）和 53%和 68%（P=0.09）。
结论
诊断为 I 期壶腹腺癌的患者的预后可能不如以前描述的那样好。我们的数据表明辅助 CRT 治疗可能有益。
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