Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma.
Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma.
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DOI：
10.1186/1471-2407-8-170
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发表时间：
2008-06-11
期刊：
影响因子：
3.8
通讯作者：
Gladhaug IP
中科院分区：
文献类型：
--
作者：
Westgaard A;Tafjord S;Farstad IN;Cvancarova M;Eide TJ;Mathisen O;Clausen OP;Gladhaug IP
可切除的胰头腺癌，定义为“壶腹周围”，起源于壶腹、十二指肠、胆管或胰腺导管上皮。通常，壶腹周围腺癌具有肠或胰胆分化类型，并且分化类型可能在解剖学上比起源的解剖部位更重要。本研究的目的是确定分化的组织学类型是否是壶腹周围腺癌的一个独立的预后因素，以及肿瘤来源是否独立于切除边缘参与，肿瘤大小，淋巴结参与，神经和血管浸润和分化程度预测胰胆管型癌的预后。114例连续切除的胰胆管（n = 67）和肠（n = 47）型分化的壶腹周围腺癌的组织学变量进行了评价，使用标准化的，系统的方案，评价切除标本（研究组）。组织学类型的分化和肿瘤的起源进行了比较，作为生存的预测因素，并通过与历史对照组进行比较，包括99个连续的胰腺癌切除术前进行标准化的组织病理学评价的结果进行了验证。通过卡方和Mann-Whitney检验评价组织病理学变量之间的相关性。通过Kaplan-Meier方法估计生存率，使用对数秩检验比较曲线，并通过单变量和多变量考克斯回归分析。在研究组（n = 114）和历史对照组（n = 99）中，分化的组织学类型独立预测生存率，而肿瘤起源仅在单变量分析中预测生存率。研究组生存率的独立不良预测因子是胰胆系统分化（p < 0.001; HR 3.1; CI 1.8-5.1），区域淋巴结受累（p < 0.001; HR 2.5; CI 1.5-4.4），血管受累（p = 0.012; HR 1.9; CI 1.2-3.1）和肿瘤直径增加（以cm为单位测量，p = 0.011; HR 1.3; CI 1.1-1.5）。对于胰胆管分化腺癌（n = 67），淋巴结状态，血管受累和肿瘤直径仍然是独立的预后因素，而肿瘤起源并不能独立预测预后，因为与肿瘤大小（p < 0.001）和淋巴结受累（p = 0.004）显著相关。胰胆系与肠型分化独立预测壶腹周围腺癌行胰十二指肠切除术后的不良预后。淋巴结受累、血管浸润和肿瘤直径增加是胰胆管分化肿瘤生存的不利预测因素。
Resectable adenocarcinomas in the pancreatic head, by definition "periampullary", originate from ampullary, duodenal, biliary, or ductal pancreatic epithelium. Typically, periampullary adenocarcinomas have either intestinal or pancreatobiliary type of differentiation, and the type of differentiation might be prognostically more important than the anatomic site of origin. The aim of the study was to determine whether the histologic type of differentiation is an independent prognostic factor in periampullary adenocarcinoma, and whether tumour origin predicts the prognosis in pancreatobiliary type carcinomas independently of resection margin involvement, tumour size, nodal involvement, perineural and vascular infiltration, and degree of differentiation. Histopathologic variables in 114 consecutively resected periampullary adenocarcinomas of pancreatobiliary (n = 67) and intestinal (n = 47) type differentiation were evaluated using a standardized, systematic protocol for evaluation of the resected specimen (study group). Histologic type of differentiation and tumour origin were compared as predictors of survival, and the results were validated by comparison with a historical control group consisting of 99 consecutive pancreaticoduodenectomies performed before standardization of histopathologic evaluation. Associations between histopathologic variables were evaluated by Chi-square and Mann-Whitney tests. Survival was estimated by the Kaplan-Meier method, comparing curves using log-rank test, and by univariate and multivariable Cox regression analysis. Both in the study group (n = 114) and in the historical control group (n = 99), the histologic type of differentiation independently predicted survival, while tumour origin predicted survival only in univariate analysis. Independent adverse predictors of survival in the study group were pancreatobiliary type differentiation (p < 0.001; HR 3.1; CI 1.8–5.1), regional lymph node involvement (p < 0.001; HR 2.5; CI 1.5–4.4), vessel involvement (p = 0.012; HR 1.9; CI 1.2–3.1), and increasing tumour diameter (measured in cm, p = 0.011; HR 1.3; CI 1.1–1.5). For pancreatobiliary differentiated adenocarcinomas (n = 67), lymph node status, vessel involvement, and tumour diameter remained independent prognostic factors, while tumour origin did not independently predict the prognosis due to significant association with tumour size (p < 0.001) and lymph node involvement (p = 0.004). Pancreatobiliary versus intestinal type of differentiation independently predicts poor prognosis after pancreaticoduodenectomy for periampullary adenocarcinoma. Lymph node involvement, vessel infiltration, and increasing tumour diameter are adverse predictors of survival in tumours with pancreatobiliary differentiation.
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影响因子：
2
作者：
Albores-Saavedra, Jorge;Simpson, Karen;Hruban, Ralph
通讯作者：
Hruban, Ralph
DOI：
10.1053/ejso.2001.1162
发表时间：
2001-09-01
期刊：
EUROPEAN JOURNAL OF SURGICAL ONCOLOGY
影响因子：
--
作者：
van Geenen, RCI;van Gulik, TM;Gouma, DJ
通讯作者：
Gouma, DJ
影响因子：
9
作者：
Yeo, CJ;Sohn, TA;Pitt, HA
通讯作者：
Pitt, HA
DOI：
10.1111/j.1349-7006.1994.tb02077.x
发表时间：
1994-02-01
期刊：
JAPANESE JOURNAL OF CANCER RESEARCH
影响因子：
--
作者：
KIMURA, W;FUTAKAWA, N;ESAKI, Y
通讯作者：
ESAKI, Y
DOI：
10.1053/ejso.2002.1307
发表时间：
2002-09-01
期刊：
EUROPEAN JOURNAL OF SURGICAL ONCOLOGY
影响因子：
--
作者：
Khan, AW;Dhillon, AP;Davidson, BR
通讯作者：
Davidson, BR