Prognosis of cancer of the duodenal papilla of Vater in relation to clinicopathological tumor extension.
Prognosis of cancer of the duodenal papilla of Vater in relation to clinicopathological tumor extension.
复制标题
十二指肠乳头癌的预后与临床病理学肿瘤扩展的关系。
作者：
A. Nakao;A. Harada;T. Nonami;W. Kishimoto;S. Takeda;K. Ito;H. Takagi
1981 ~ 1991年，28例十二指肠乳头癌中26例（92%）行手术治疗。25例患者接受了胰腺切除术，1例患者接受了全胰腺切除术。这26例患者无手术或住院死亡。5年累计生存率为52%。在26例患者中，我们提交了手术切除的组织标本进行组织病理学检查，并进行免疫组化分析，使用各种胃肠癌抗原的抗体。我们分析了结果与预后的关系。发现癌症的组织学分期与预后相关。胰腺实质癌患者的预后特别差。有些表现出神经周围侵犯。癌细胞浸润到胰腺实质的患者常表现为免疫组化染色的II级阳性反应，其染色模式与胰腺导管细胞癌相似。在癌症浸润没有超出Oddi括约肌的患者中，5年生存率为100%。因此，未侵犯Oddi括约肌以外的乏特乳头癌可视为乏特乳头癌的早期。这些结果表明，手术治疗乏特乳头癌的基础上，应选择一个准确的术前评估癌症的各种成像技术（主要是超声内镜）的侵袭，晚期乏特乳头癌的治疗不仅需要广泛的手术切除，但也是一个更有效的多学科的治疗计划。
Between 1981 and 1991, cancer of the duodenal papilla of Vater was surgically treated in 26 out of 28 cases (92%). Twenty-five patients underwent pancreatoduodenectomy and one had a total pancreatectomy. There were no surgical or hospital deaths in these 26 patients. Their five-year cumulative survival rate was 52%. In the 26 patients, we submitted the surgically removed tissue specimens to histopathological examination and performed immunohistochemical analysis using antibodies against various gastrointestinal cancer antigens. We analyzed the results in relation to the prognosis. The histological stage of the cancer was found to correlate with the prognosis. Patients having cancer invading the pancreatic parenchyma had a particularly poor prognosis. Some exhibited perineural invasion. Patients with cancer invasion into the pancreatic parenchyma frequently showed a grade II positive response to immunohistochemical staining, with a staining pattern similar to that of pancreatic duct cell carcinoma. In patients in whom cancer invasion did not extend beyond the sphincter of Oddi, the five-year survival rate was 100%. Therefore, cancer of the papilla of Vater which has not invaded beyond the the sphincter of Oddi, may be regarded as early cancer of the papilla of Vater. These results indicate that surgical procedures for cancer of the papilla of Vater should be selected on the basis of an accurate preoperative evaluation of cancer invasion by various imaging techniques (chiefly endoscopic ultrasonography), and that the treatment of advanced cancer of the papilla of Vater requires not only extensive surgical resection but also a more effective multi-disciplinary treatment plan.