Buchbjerg T, Fristrup C, Mortensen M B
Department of Surgery, Odense University Hospital, Sdr. Boulevard, DK-5000, Odense C, Denmark.
Department of Surgery, Odense University Hospital, Sdr. Boulevard, DK-5000, Odense C, Denmark.
Surg Oncol. 2015 Jun;24(2):110-6. doi: 10.1016/j.suronc.2015.04.004. Epub 2015 Apr 22.
Primary duodenal carcinoma (PDC) is a rare gastrointestinal tumor. The difficult distinction between PDC and other types of carcinoma (e.g. within the periampullary region) is reflected in the scarce literature on true duodenal carcinomas. However, this distinction may be important in relation to the overall prognosis as well as in the choice of adjuvant or palliative treatment strategies. The aim of this study was to evaluate the incidence, management and prognosis of patients with true PDC within a well-defined geographical area.
Retrospective analysis of all patients diagnosed with true PDC from 1997 to 2012 within the Region of Southern Denmark. Only patients where the surgeon and the pathologist agreed on the tumor being classified as originating from the duodenum were included.
Seventy-one patients (43 M, 28 F) with a mean age of 67 years (range 35-87) met the criteria for true PDC. The incidence was 5.4 per 1,000,000, and the pathological classification was: Adenocarcinoma 87%, mucinous adenocarcinoma 7%, carcinoma 4% and signet ring cell carcinoma 1%. Intended curative resection was performed in 28 patients (39%) (22 Whipple procedures and 6 local resections), and all but one patient had negative resection margins. Thirteen patients (46%) had lymph node metastasis. Twenty-nine (67%) of the palliative treated patients had a single (n = 24) or double by-pass procedure (n = 5). The median and 5-year survival for the resected patients were 23 months (CI 7-44) and 27% (CI 10-44). The median survival in the palliative group was 5 months (CI 2-11), and none of the patients were alive after three years.
The incidence of true PDC within a geographical and histopathologically completely monitored area was 5.4 per 1,000,000. Less than 40% of the patients could be resected and they had a median survival of 23 month and an estimated 5-year survival of 27%. The prognosis of true PDC seemed lower than expected according to previously published data.
原发性十二指肠癌（PDC）是一种罕见的胃肠道肿瘤。PDC与其他类型癌症（如壶腹周围区域的癌症）之间难以区分，这一点在关于真正十二指肠癌的稀少文献中有所体现。然而，这种区分对于总体预后以及辅助或姑息治疗策略的选择可能很重要。本研究的目的是评估在一个明确界定的地理区域内真正PDC患者的发病率、治疗方法和预后。
对1997年至2012年在丹麦南部地区诊断为真正PDC的所有患者进行回顾性分析。仅纳入外科医生和病理学家一致认为肿瘤起源于十二指肠的患者。
71例患者（43例男性，28例女性）符合真正PDC的标准，平均年龄67岁（范围35 - 87岁）。发病率为每100万人中5.4例，病理分类为：腺癌87%，黏液腺癌7%，未分化癌4%，印戒细胞癌1%。28例患者（39%）进行了根治性切除（22例Whipple手术和6例局部切除），除1例患者外，所有患者切缘阴性。13例患者（46%）有淋巴结转移。29例（67%）接受姑息治疗的患者进行了单次（n = 24）或两次旁路手术（n = 5）。接受切除手术患者的中位生存期和5年生存率分别为23个月（可信区间7 - 44）和27%（可信区间10 - 44）。姑息治疗组的中位生存期为5个月（可信区间2 - 11），3年后无患者存活。
在一个地理和组织病理学完全监测的区域内，真正PDC的发病率为每100万人中5.4例。不到40%的患者能够接受切除手术，他们的中位生存期为23个月，估计5年生存率为27%。根据先前发表的数据，真正PDC的预后似乎低于预期。
