Nishio Kohei, Kimura Kenjiro, Murata Akihiro, Ohira Go, Shinkawa Hiroji, Kodai Shintaro, Amano Ryosuke, Tanaka Shogo, Shimizu Sadatoshi, Takemura Shigekazu, Kanazawa Akishige, Kubo Shoji, Ishizawa Takeaki
Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University, Osaka 5458585, Japan.
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, Osaka 5340021, Japan.
World J Gastrointest Surg. 2022 Nov 27;14(11):1219-1229. doi: 10.4240/wjgs.v14.i11.1219.
Few studies compared the oncological and biological characteristics between ampullary carcinoma (AC) and cancer of the second portion of the duodenum (DC-II), although both tumors arise from anatomically close locations.
To elucidate differences in clinicopathological characteristics, especially the patterns of lymph node metastasis (LNM), between AC and DC-II.
This was a retrospective cohort study of 80 patients with AC and 27 patients with DC-II who underwent pancreaticoduodenectomy between January 1998 and December 2018 in two institutions. Clinicopathological factors, LNM patterns, and prognosis were compared between the two groups.
The patients with AC and DC-II did not exhibit significant differences in 5-year overall survival (66.0% and 67.1%, respectively) and 5-year relapse-free survival (63.5% and 62.2%, respectively). Compared to the patients with DC-II, the rate of preoperative biliary drainage was higher ( = 0.042) and the rates of digestive symptoms ( = 0.0158), ulcerative-type cancer ( < 0.0001), large tumor diameter ( < 0.0001), and advanced tumor stage ( = 0.0019) were lower in the patients with AC. The LNM rates were 27.5% and 40.7% in patients with AC and DC-II, respectively, without significant difference ( = 0.23). The rates of LNM to hepatic nodes (N-He) and pyloric nodes (N-Py) were significantly higher in patients with DC-II than in those with AC (metastasis to N-HE: 18.5% and 5% in patients with DC-II and AC, respectively; = 0.0432; metastasis to N-Py: 11.1% and 0% in patients with DC-II and AC, respectively; = 0.0186).
Although there were no significant differences in the prognosis and recurrence rates between the two groups, metastases to N-He and N-Py were more frequent in patients with DC-II than in those with AC.
尽管壶腹癌（AC）和十二指肠第二段癌（DC-II）均起源于解剖位置相近的部位，但很少有研究比较二者的肿瘤学和生物学特征。
阐明AC和DC-II在临床病理特征上的差异，尤其是淋巴结转移（LNM）模式。
这是一项回顾性队列研究，研究对象为1998年1月至2018年12月期间在两家机构接受胰十二指肠切除术的80例AC患者和27例DC-II患者。比较两组的临床病理因素、LNM模式和预后。
AC和DC-II患者的5年总生存率（分别为66.0%和67.1%）和5年无复发生存率（分别为63.5%和62.2%）无显著差异。与DC-II患者相比，AC患者术前胆道引流率更高（P = 0.042），消化症状发生率（P = 0.0158）、溃疡型癌发生率（P < 0.0001）、肿瘤直径较大（P < 0.0001）和肿瘤晚期发生率（P = 0.0019）更低。AC和DC-II患者的LNM率分别为27.5%和40.7%，无显著差异（P = 0.23）。DC-II患者肝门淋巴结（N-He）和幽门淋巴结（N-Py）转移率显著高于AC患者（N-HE转移：DC-II患者和AC患者分别为18.5%和5%；P = 0.0432；N-Py转移：DC-II患者和AC患者分别为11.1%和0%；P = 0.0186）。
尽管两组患者的预后和复发率无显著差异，但DC-II患者N-He和N-Py转移比AC患者更常见。
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