8339例老年尸检患者中15例隐匿性和178例临床胰腺导管腺癌的临床病理特征

Clinicopathological Features of 15 Occult and 178 Clinical Pancreatic Ductal Adenocarcinomas in 8339 Autopsied Elderly Patients.

作者信息

Matsuda Yoko, Ishiwata Toshiyuki, Yachida Shinichi, Suzuki Akemi, Hamashima Yuri, Hamayasu Hideki, Yoshimura Hisashi, Honma Naoko, Aida Junko, Takubo Kaiyo, Arai Tomio

机构信息

From the *Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku; †Department of Pathology and Integrative Oncological Pathology, Nippon Medical School, Bunkyo-ku; ‡Division of Cancer Genomics, National Cancer Center Research Institute, Chuo-ku; and §Research Team for Geriatric Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan.

出版信息

Pancreas. 2016 Feb;45(2):234-40. doi: 10.1097/MPA.0000000000000447.

DOI:10.1097/MPA.0000000000000447

PMID:26474426

Abstract

OBJECTIVE

The aim of the study was to investigate the clinicopathological features of pancreatic cancer at different stages using autopsy results.

METHODS

We retrospectively evaluated 8399 consecutive cases of autopsy performed between 1972 and 2013 at our geriatric hospital.

RESULTS

Macroscopic pancreatic lesions were detected in 6.13% of the cases. Primary and secondary pancreatic tumors were observed in 2.88% and 2.10% of the cases, respectively. Most primary tumors were invasive ductal adenocarcinomas (193 cases [2.31%]; mean patient age, 78.09 years) with a peak incidence at 50 to 59 years. Occult invasive ductal adenocarcinoma was discovered incidentally in 15 cases, with distant metastasis present in 26.67% of those. Microscopically, occult and advanced tumors exhibited similar characteristics such as hyalinized fibrous stroma, necrosis, invasion into vessels, peripancreatic fat tissues, and extrapancreatic nerve plexus. Mucin 1 and 2 immunohistochemical expression levels were also similar. Occult cancer incidence increased with age. Patients aged 85 years or older had shorter survival, a small tumor size, and a low incidence of lymph node metastasis. Approximately 8% of pancreatic invasive ductal adenocarcinomas progressed asymptomatically and were discovered incidentally at autopsy.

CONCLUSIONS

Pancreatic cancers in elderly patients tend to progress asymptomatically, but once symptoms develop, they are more often fatal than those in younger patients.

摘要

目的

本研究旨在利用尸检结果调查不同阶段胰腺癌的临床病理特征。

方法

我们回顾性评估了1972年至2013年间在我院老年医院连续进行的8399例尸检病例。

结果

6.13%的病例发现有胰腺宏观病变。原发性和继发性胰腺肿瘤分别在2.88%和2.10%的病例中观察到。大多数原发性肿瘤为浸润性导管腺癌（193例[2.31%]；患者平均年龄78.09岁），发病高峰在50至59岁。15例偶然发现隐匿性浸润性导管腺癌，其中26.67%有远处转移。在显微镜下，隐匿性和晚期肿瘤表现出相似的特征，如透明化纤维间质、坏死、血管浸润、胰腺周围脂肪组织浸润和胰腺外神经丛浸润。黏蛋白1和2免疫组化表达水平也相似。隐匿性癌的发病率随年龄增长而增加。85岁及以上患者的生存期较短，肿瘤体积较小，淋巴结转移发生率较低。约8%的胰腺浸润性导管腺癌无症状进展，在尸检时偶然发现。