Baghmar Saphalta, Agrawal Nikhil, Kumar Guresh, Bihari Chhagan, Patidar Yashwant, Kumar Senthil, Chattopadhyay Tushar Kanti, Panda Dipanjan, Arora Asit, Pamecha Viniyendra
Department of Medical Oncology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110070, India.
Department of Hepatopancreatobiliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110070, India.
J Gastrointest Cancer. 2019 Sep;50(3):361-369. doi: 10.1007/s12029-018-0058-7.
The effect of adjuvant treatment on those undergoing pancreaticoduodenectomy (PD) for periampullary carcinomas (PAC) is not well studied. Most studies employed chemoradiation as the adjuvant modality. We aimed to analyse clinicopathological differences between types of PACs, the prognostic factors and the role of adjuvant therapy (chemotherapy in the majority).
Patients with PAC who underwent PD from Jan 2011 to Dec 2015 were retrospectively analysed.
Ninety-five patients with PAC underwent PD in the study period. Ampullary carcinoma (AC) was the most common. Pancreatic carcinomas (PC) were larger. AC had lower T stage, perineural invasion (PNI) and R1 resections. Median overall survival (OS) was 32.7 months. On multivariate analysis, lymph node ratio (LNR) ≥ 0.2 and advanced T stage adversely affected the OS. Fifty-seven (66.3%) patients received adjuvant treatment, of which 50 had chemotherapy alone. Adjuvant treatment resulted in better OS in patients with T stage ≥ 3, lymph node involvement, LNR ≥ 0.2, lymphovascular invasion, PNI, tumour size > 2 cm, higher grade and distal cholangiocarcinoma.
In patients of PAC undergoing PD, AC had favourable clinicopathological profile. LNR ≥ 0.2 and advanced T stage adversely affected OS. Adjuvant treatment resulted in significantly better OS in patients with high-risk features.
辅助治疗对接受胰十二指肠切除术（PD）的壶腹周围癌（PAC）患者的影响尚未得到充分研究。大多数研究采用放化疗作为辅助治疗方式。我们旨在分析不同类型PAC的临床病理差异、预后因素以及辅助治疗（大多数为化疗）的作用。
对2011年1月至2015年12月期间接受PD的PAC患者进行回顾性分析。
在研究期间，95例PAC患者接受了PD。壶腹癌（AC）最为常见。胰腺癌（PC）体积更大。AC的T分期较低，神经周围侵犯（PNI）和R1切除率较低。中位总生存期（OS）为32.7个月。多因素分析显示，淋巴结比率（LNR）≥0.2和T分期进展对OS有不利影响。57例（66.3%）患者接受了辅助治疗，其中50例仅接受了化疗。辅助治疗使T分期≥3、有淋巴结受累、LNR≥0.2、有淋巴管侵犯、PNI、肿瘤大小>2 cm、高分级和远端胆管癌患者的OS更好。
在接受PD的PAC患者中，AC具有良好的临床病理特征。LNR≥0.2和T分期进展对OS有不利影响。辅助治疗使具有高危特征的患者的OS显著改善。
