The clinicopathological differences of sporadic non-ampullary duodenal epithelial neoplasm depending on tumor location
The clinicopathological differences of sporadic non-ampullary duodenal epithelial neoplasm depending on tumor location
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DOI：
10.1111/jgh.14640
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发表时间：
2019-09-01
影响因子：
4.1
通讯作者：
Okada, Hiroyuki
中科院分区：
文献类型：
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作者：
Matsueda, Katsunori;Kanzaki, Hiromitsu;Okada, Hiroyuki
背景和目的虽然散发性十二指肠非壶腹腺瘤被推测为癌前病变，但由于其罕见性，腺瘤与癌之间的关系仍不清楚。以往对散发性非壶腹十二指肠上皮性肿瘤（SNADEN）的研究主要针对浅表肿瘤，如腺瘤和早期癌。其临床病理特征，包括晚期癌的临床病理特征，仍然研究得很少。我们评估了SNADEN的临床病理学特征，包括晚期癌，重点是肿瘤位置。方法我们回顾性收集了2002年6月至2014年3月期间在日本11家机构中临床和病理诊断为SNADEN的410例患者的数据。结果321例（78.3%）SNADEN为粘膜瘤变，89例（21.7%）为浸润癌。SNADEN中浸润性癌发生在乳头口侧（oral-Vater）明显高于肛侧（anal-Vater）（27.9%vs14.4%，P < 0.001）。未分化型癌发生率口腔型Vater明显高于肛门型Vater（38.7%比14.8%，P = 0.026）。局部晚期癌R 0手术切除的复发率口腔-Vater术显著高于肛门-Vater术（46.4%vs8.3%，P = 0.021）。此外，口服-Vater的无复发生存期显著短于肛门-Vater（风险比：2.35; 95%置信区间：1.09-5.50; P = 0.028）。结论口-腹型与肛-腹型SNADEN的临床病理特征不同。口腔-Vater上的SNADEN更可能是浸润性癌，并且由于生物学恶性度高于肛门-Vater上的SNADEN，其行为可能更具侵袭性。
Background and Aim Although sporadic non-ampullary duodenal adenoma is speculated to be precancerous lesion, the relationship between adenoma and carcinoma remains unclear due to their rarity. Previous studies on sporadic non-ampullary duodenal epithelial neoplasm (SNADEN) have mainly targeted superficial tumors, like adenoma and early carcinoma. The clinicopathological features, including those of advanced carcinoma, remain poorly investigated. We assessed the clinicopathological features of SNADEN, including advanced carcinoma, focusing on tumor location. Methods We retrospectively collected the data of 410 patients who had been clinically and pathologically diagnosed with SNADEN at 11 institutions in Japan between June 2002 and March 2014. Results The SNADEN was mucosal neoplasia and invasive carcinoma in 321 (78.3%) and 89 (21.7%) patients, respectively. The proportion of invasive carcinomas in SNADEN was significantly higher on the oral side of the papilla of Vater (oral-Vater) than on the anal side (anal-Vater) (27.9% vs 14.4%, P < 0.001). Undifferentiated-type carcinoma was significantly more frequent with oral-Vater than anal-Vater (38.7% vs 14.8%, P = 0.026). The recurrence rate of surgically R0 resected locally advanced carcinomas was significantly higher with oral-Vater than anal-Vater (46.4% vs 8.3%, P = 0.021). Furthermore, the relapse-free survival with oral-Vater was significantly shorter than with anal-Vater (hazard ratio: 2.35; 95% confidence interval: 1.09-5.50; P = 0.028). Conclusions The clinicopathological features of SNADEN on oral-Vater were different from those on anal-Vater. SNADEN on oral-Vater was more likely to be invasive carcinomas and might behave more aggressively due to biologically higher malignancy than that on anal-Vater.