Xia Tao, Wu Xiaosan, Mou Yiping, Xu Yunyun, Zhou Yucheng, Lu Chao, Zhu Qicong, Jin Weiwei, Chen Yuan
Department of Gastrointestinal-Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China.
Department of Surgery, Bengbu Medical College, Bengbu, China.
Front Oncol. 2021 Feb 18;11:616108. doi: 10.3389/fonc.2021.616108. eCollection 2021.
Adenocarcinoma of the ampulla of Vater (AAV) is standardly treated using a complex operation, a pancreatoduodenectomy (PD), to remove the tumor. However, dicision-making in AAV clinical treatment remains difficult due to the broad range of AAV types, outcomes, and responses to special chemotherapeutics. Thus, this study aimed to explore clinicopathological prognostic factors associated with overall survival, as well as post-chemotherapeutic effects related to curative resection of AAV.
We retrospectively reviewed data for clinicopathological outcome of 47 patients diagnosed with AAV that had underwent a PD. Overall survival probabilities were obtained using the Kaplan-Meier estimate method and a Cox proportional hazards model.
Forty-five patients underwent LPD (laparoscopic pancreatoduodenectomy) and two patients underwent PD. The patient group was composed of 31 males (66%) and 16 females (34%) with a mean age of 65(34-91)years. We selected 45 patients for long-term survival analysis. One- and three-year overall survival rates after resection were 97.6% and 58.9% respectively. The median survival was 37.7 months for the intestinal-type and 26.9 months in pancreatobiliary-type ampullary tumors. Serum carbohydrate antigen (CA) 19-9 greater than 37 U/ml (HR 0.140, P = 0.007), perineural invasion (HR 0.141, P = 0.003), and classification as pancreatobiliary-type (HR 6.633, P = 0.006) were independently associated with poor survival. Serum carcinoembryonic antigen (CEA) greater than 5 µg/ml (P = 0.031), serum CA 19-9 greater than 37 U/ml (P = 0.002), tumor sizes greater than 2.5cm (P=0.002), and positive perineural invasion (P=0.003) were all associated with a poor prognosis in the histopathological subgroup. Serum CA 19-9 greater than 37 U/ml (P=0.002) and positive perineural invasion (P=0.001) were significantly associated with poor survival in of patients with intestinal-type ampullary tumors. Serum CEA greater than 5 µg/ml (P=0.013) and tumor sizes greater than 2.5cm (P=0.002) were significantly associated with poor survival in patients with pancreatobiliary-type ampullary tumors.
Pancreatobiliary-type ampullary tumors were associated with poor survival. Serum CA 19-9 in the intestinal-type and CEA in the pancreatobiliary-type were significantly associated with poor survival. Ajuvant chemotherapy could not predict the survival of AAV patients.
标准情况下，采用复杂手术即胰十二指肠切除术（PD）来切除 Vater 壶腹腺癌（AAV）。然而，由于 AAV 类型、预后以及对特殊化疗药物的反应范围广泛，AAV 临床治疗中的决策仍然困难。因此，本研究旨在探讨与总生存相关的临床病理预后因素，以及与 AAV 根治性切除相关的化疗后效果。
我们回顾性分析了 47 例行 PD 的 AAV 确诊患者的临床病理结果数据。采用 Kaplan-Meier 估计法和 Cox 比例风险模型获得总生存概率。
45 例患者接受了腹腔镜胰十二指肠切除术（LPD），2 例患者接受了 PD。患者组由 31 名男性（66%）和 16 名女性（34%）组成，平均年龄为 65（34 - 91）岁。我们选择 45 例患者进行长期生存分析。切除术后 1 年和 3 年的总生存率分别为 97.6%和 58.9%。肠型壶腹肿瘤的中位生存期为 37.7 个月，胰胆型壶腹肿瘤为 26.9 个月。血清糖类抗原（CA）19 - 9 大于 37 U/ml（HR 0.140，P = 0.007）、神经周围侵犯（HR 0.141，P = 0.003）以及分类为胰胆型（HR 6.633，P = 0.006）与生存不良独立相关。血清癌胚抗原（CEA）大于 5 µg/ml（P = 0.031）、血清 CA 19 - 9 大于 37 U/ml（P = 0.002）、肿瘤大小大于 2.5cm（P = 0.002）以及神经周围侵犯阳性（P = 0.003）在组织病理学亚组中均与预后不良相关。血清 CA 19 - 9 大于 37 U/ml（P = 0.002）和神经周围侵犯阳性（P = 0.001）在肠型壶腹肿瘤患者中与生存不良显著相关。血清 CEA 大于 5 µg/ml（P = 0.013）和肿瘤大小大于 2.5cm（P = 0.002）在胰胆型壶腹肿瘤患者中与生存不良显著相关。
胰胆型壶腹肿瘤与生存不良相关。肠型中的血清 CA 19 - 9 和胰胆型中的 CEA 与生存不良显著相关。辅助化疗无法预测 AAV 患者的生存情况。
