Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
Asian J Surg. 2020 Dec;43(12):1133-1141. doi: 10.1016/j.asjsur.2020.03.007. Epub 2020 Apr 2.
Ampullary cancer is a relatively rare gastrointestinal malignancy. The purpose of this study was to evaluate prognostic factors for survival and assess the benefits of adjuvant therapy following pancreaticoduodenectomy for this entity. Medline and EMBASE databases were searched to identify eligible studies from January 2000 to August 2019. Review Manager 5.3 statistical software was used for meta-analysis. 71 studies met the inclusion criteria and were included in the analysis for a total of 8280 patients. The median (range) 5-year overall survival and disease-free survival rates were 58% (32-82%) and 51% (28-73%) respectively. In meta-analysis, age >65 years at diagnosis, tumor size >20 mm, poor differentiation, pancreaticobiliary histotype, pT3-4 stage disease, presence of metastatic lymph node, number of metastatic nodes, perineural invasion, lymphovascular invasion, vascular invasion, pancreatic invasion, and positive surgical margins were independently associated with worse overall survival, whereas adjuvant therapy was associated with improved overall survival. In summary, in patients with ampullary cancer undergoing pancreaticoduodenectomy, tumor factors are the main predictors of worse survival and adjuvant treatment confers a survival benefit.
壶腹癌是一种相对罕见的胃肠道恶性肿瘤。本研究旨在评估生存的预后因素，并评估胰腺十二指肠切除术后辅助治疗对该实体的益处。通过 Medline 和 EMBASE 数据库检索 2000 年 1 月至 2019 年 8 月期间的合格研究。使用 Review Manager 5.3 统计软件进行荟萃分析。71 项研究符合纳入标准，共纳入 8280 例患者进行分析。中位（范围）5 年总生存率和无病生存率分别为 58%（32-82%）和 51%（28-73%）。荟萃分析显示，诊断时年龄>65 岁、肿瘤大小>20mm、分化差、胰胆管组织学类型、pT3-4 期疾病、存在转移性淋巴结、转移淋巴结数量、神经周围侵犯、血管侵犯、胰腺侵犯和阳性手术切缘与总生存率较差独立相关，而辅助治疗与总生存率提高相关。总之，在接受胰腺十二指肠切除术的壶腹癌患者中，肿瘤因素是生存较差的主要预测因素，辅助治疗可带来生存获益。
