Factors Predicting Survival and Pathological Subtype in Patients With Ampullary Adenocarcinoma
Factors Predicting Survival and Pathological Subtype in Patients With Ampullary Adenocarcinoma
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DOI：
10.1002/jso.23600
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发表时间：
2014-08-01
影响因子：
2.5
通讯作者：
Suzuki, Yasuyuki
中科院分区：
文献类型：
--
作者：
Okano, Keiichi;Oshima, Minoru;Suzuki, Yasuyuki
背景：Vater 壶腹癌并不常见。本研究旨在阐明壶腹腺癌生存的预测因素，并确定其两种主要病理亚型的特征。方法：回顾了 2000 年至 2012 年间在日本香川县 12 家主要医院接受壶腹腺癌根治性切除术的 86 例患者的病历。结果：切除术在 75-79 岁的患者中最为常见。壶腹腺癌的精算术后1年、3年和5年生存率分别为90%、72.3%和69.1%。术前胆道引流；血清CA19-9和总胆红素水平；病理分级；神经周围、血管、胰腺和十二指肠侵犯；淋巴结转移； UICC-T阶段；和胰胆亚型是生存不良的预测因素。血清 CA19-9 水平升高；总胆红素水平升高；淋巴管、血管、神经周围和胰腺侵犯；与肠型肿瘤患者相比，胰胆管型肿瘤患者的总体肿瘤分期较晚更常见。另外，病理亚型分析显示各亚型具有不同的预后因素。结论：术前血清CA19-9和总胆红素水平升高是壶腹腺癌的预后因素，且均与胰胆型肿瘤相关。外科医生应该意识到这些因素，因为胰胆管型腺癌具有侵袭性，并且与较差的生存率相关。 (C) 2014 年 Wiley 期刊公司。
Background: Carcinoma of the ampulla of Vater is uncommon. This study aimed to clarify predictors of survival for ampullary adenocarcinoma and to identify characteristics of its two major pathological subtypes.Methods: Medical records were reviewed for 86 patients who underwent curative resection for ampullary adenocarcinoma between 2000 and 2012 at 12 principal hospitals in Kagawa, Japan.Results: Resection was most common among 75-79-year-old patients. Actuarial 1-, 3-, and 5-year postoperative survival rates for ampullary adenocarcinoma were 90%, 72.3%, and 69.1%, respectively. Preoperative biliary drainage; serum CA19-9 and total bilirubin levels; pathological grade; perineural, vascular, pancreatic, and duodenal invasion; nodal metastasis; UICC-T stage; and pancreatobiliary subtype were predictors of poor survival. An elevated serum CA19-9 level; an elevated total bilirubin level; lymphatic, vascular, perineural, and pancreatic invasion; and advanced overall tumor stage were more common in patients with pancreatobiliary-type tumors than in patients with intestinal-type tumors. Additionally, pathologic subtype analysis showed that each subtype had distinct prognostic factors.Conclusions: Preoperative elevated serum CA19-9 and total bilirubin levels are prognostic factors for ampullary adenocarcinoma, and are both associated with pancreatobiliary-type tumors. Surgeons should be aware of these factors because pancreatobiliary-type adenocarcinoma is aggressively invasive and is associated with poor survival. (C) 2014 Wiley Periodicals, Inc.