Department of Pathology, Instituto Nacional de Cancerología, Ciudad de México 14080, Mexico.
Personalized Medicine Laboratory, Instituto Nacional de Cancerología, Ciudad de México 14080, Mexico.
Hum Pathol. 2019 Jan;83:68-76. doi: 10.1016/j.humpath.2018.08.024. Epub 2018 Sep 1.
Adenocarcinomas of the ampulla of Vater account for 0.5% of malignant neoplasms of the gastrointestinal tract and 6% to 20% of malignant periampullary neoplasms, with most patients being candidates for elective surgery. Our objective was to evaluate the clinicopathological prognostic factors of ampullary adenocarcinomas after surgical resection in a Mexican population. From the records of the Department of Pathology at the Instituto Nacional de Cancerología, México, cases diagnosed as adenocarcinomas of the ampulla of Vater were selected over a period of 11 years, from January 2005 to September 2015. Cases with a pancreaticoduodenectomy report were included, and from each case, demographic and pathological data of the surgical specimen were obtained. Univariate and multivariate statistical analyses were performed using the log-rank test and Cox regression. Of 157 cases diagnosed as ampullary adenocarcinomas, 104 patients were excluded as not eligible for surgical treatment at the time of diagnosis. In the remaining 53 patients, a pancreaticoduodenectomy was performed. The mean age of the entire group was 55.4 years, and most were men. Intestinal-type adenocarcinomas were more frequent (77.4%) than pancreatobiliary-type (15.1%), with most being without perineural invasion, well to moderately differentiated, and less than 3 cm in size. Lymph node metastasis and age greater than 65 years had a negative impact on overall survival of the patients. The most convenient classification of malignant epithelial tumors of the Vaterian system is according to the histopathologic phenotype grouped into intestinal-, pancreatobiliary-, and mixed-type adenocarcinomas, as well as uncommon variants.
Vater 壶腹腺癌占胃肠道恶性肿瘤的 0.5%，占恶性胰胆管周围肿瘤的 6%至 20%，大多数患者是择期手术的候选者。我们的目的是评估在墨西哥人群中经手术切除的壶腹腺癌的临床病理预后因素。从墨西哥国立癌症研究所病理科的记录中，选择了 11 年来（2005 年 1 月至 2015 年 9 月）诊断为 Vater 壶腹腺癌的病例。纳入有胰十二指肠切除术报告的病例，并从每个病例中获取手术标本的人口统计学和病理学数据。使用对数秩检验和 Cox 回归进行单变量和多变量统计分析。在 157 例诊断为壶腹腺癌的病例中，有 104 例由于在诊断时不符合手术治疗条件而被排除。在其余 53 例患者中，进行了胰十二指肠切除术。整个组的平均年龄为 55.4 岁，大多数为男性。肠型腺癌（77.4%）比胰胆管型腺癌（15.1%）更常见，大多数无神经周围侵犯，分化良好至中度，且肿瘤直径小于 3cm。淋巴结转移和年龄大于 65 岁对患者的总生存有负面影响。Vater 系统恶性上皮肿瘤最方便的分类是根据组织病理学表型分为肠型、胰胆管型和混合型腺癌以及罕见的变异型。
