比较两种特定部位壶腹癌的临床特征和预后因素。

Comparison of clinical characteristics and prognostic factors in two site-specific categories of ampullary cancer.

机构信息

Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China.

出版信息

World J Gastroenterol. 2024 Oct 21;30(39):4281-4294. doi: 10.3748/wjg.v30.i39.4281.

DOI:10.3748/wjg.v30.i39.4281

PMID:39492830

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11525854/

Abstract

BACKGROUND

Ampullary cancer is a relatively rare malignant tumor in the digestive system. Its incidence has increased in recent years. As for now, its biological characteristics have not been fully clarified. Recent studies have primarily focused on the histological classification and genetic changes, but there are fewer investigations into the differences among site-specific subgroups. The clinicopathological characteristics of ampullary cancer occurring in different positions have not been elucidated. Furthermore, the role of adjuvant therapy in the treatment of patients with ampullary cancer remains controversial.

AIM

To study the clinicopathological features of the two site-specific subgroups of ampullary cancer and explore the factors affecting prognosis.

METHODS

A total of 356 patients who met the inclusion and exclusion criteria were enrolled. Patients were divided into ampulla of Vater cancer (AVC) and duodenal papilla cancer (DPC) based on the gross and microscopic findings. Baseline data, admission examination results, and perioperative outcomes were collected and analyzed. The Kaplan-Meier curve was used for survival analysis. Univariate and multivariate analysis was performed to explore the independent risk factors affecting the overall survival (OS) of both groups.

RESULTS

The preoperative total bilirubin level in patients with AVC was significantly higher than those with DPC ( = 0.04). The OS for patients with DPC was 58.90 ± 38.74 months, significantly longer than 44.31 ± 35.90 months for patients with AVC ( < 0.01). The independent risk factors affecting the OS of AVC included: Preoperative albumin level ( = 0.009), total bilirubin level ( = 0.017), and number of positive lymph nodes ( = 0.005). For DPC, risk factors included: Age ( = 0.004), tumor size ( = 0.023), number of positive lymph nodes ( = 0.010) and adjuvant treatment ( = 0.020). Adjuvant therapy significantly improved the OS rate of patients with DPC, but not for those with AVC.

CONCLUSION

Patients with AVC had a shorter OS compared to those with DPC. The prognosis factors and the role of adjuvant therapy of two groups were different.

摘要

背景

壶腹癌是消化系统中一种相对罕见的恶性肿瘤。近年来，其发病率有所增加。目前，其生物学特性尚未完全阐明。最近的研究主要集中在组织学分类和遗传变化上，但对特定部位亚组之间差异的研究较少。不同部位壶腹癌的临床病理特征尚未阐明。此外，辅助治疗在壶腹癌患者治疗中的作用仍存在争议。

目的

研究两种特定部位壶腹癌亚组的临床病理特征，并探讨影响预后的因素。

方法

共纳入符合纳入和排除标准的 356 例患者。根据大体和显微镜检查结果，将患者分为壶腹癌（AVC）和十二指肠乳头癌（DPC）。收集并分析基线数据、入院检查结果和围手术期结果。采用 Kaplan-Meier 曲线进行生存分析。采用单因素和多因素分析探讨两组患者总生存（OS）的独立危险因素。

结果

AVC 患者术前总胆红素水平明显高于 DPC 患者（ = 0.04）。DPC 患者的 OS 为 58.90 ± 38.74 个月，明显长于 AVC 患者的 44.31 ± 35.90 个月（ < 0.01）。影响 AVC OS 的独立危险因素包括：术前白蛋白水平（ = 0.009）、总胆红素水平（ = 0.017）和阳性淋巴结数（ = 0.005）。对于 DPC，危险因素包括：年龄（ = 0.004）、肿瘤大小（ = 0.023）、阳性淋巴结数（ = 0.010）和辅助治疗（ = 0.020）。辅助治疗显著提高了 DPC 患者的 OS 率，但对 AVC 患者没有影响。