PANCREATICODUODENAL CARCINOMA - A CLINICOPATHOLOGICAL STUDY OF 304 PATIENTS AND IMMUNOHISTOCHEMICAL OBSERVATION FOR CEA AND CA19-9
PANCREATICODUODENAL CARCINOMA - A CLINICOPATHOLOGICAL STUDY OF 304 PATIENTS AND IMMUNOHISTOCHEMICAL OBSERVATION FOR CEA AND CA19-9
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DOI：
10.1002/jso.2930470303
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发表时间：
1991-07-01
影响因子：
2.5
通讯作者：
TSUNEYOSHI, M
中科院分区：
文献类型：
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作者：
YAMAGUCHI, K;ENJOJI, M;TSUNEYOSHI, M
本文对304例胰十二指肠癌的临床病理和免疫组织化学进行了研究，以明确4种不同起源部位的癌的特征；壶腹癌（Am）、胆总管远端癌（DCBD）、胰头癌（PH）和壶腹外十二指肠癌（Du）。87 PH的平均最大直径为3.5 cm，而149 Am和DCBD的平均最大直径分别为2.7 cm和2.7 cm。组织病理学上，40%的Am为乳头状腺癌，而DCBD、PH和Du约有一半为管状腺癌。PH侵袭淋巴（85%）、血管（62%）和神经周围（95%）间隙和淋巴结转移（72%）的频率分别高于Am（77%、35%、24%、50%）、DCBD（47%、61%、65%、45%）和Du（76%、29%、35%、65%）。超过50%的PH侵入切除边缘，而只有2%的Am手术边缘受到恶性细胞的影响。免疫组化结果显示，PH对癌胚抗原（CEA）（98%）和碳水化合物抗原（CA） 19-9（91%）的阳性均高于Am（83%, 62%）、DCBD（94%, 58%）和Du（56%, 11%）。CEA和CA19-9间质染色型在PH（27%, 44%）中比在Am（9%, 31%）、DCBD（11%, 8%）和Du（0%, 0%）中更常见，显示PH的去分化性更强。87例PH患者（15%）的累积3年生存率低于Am患者149例（42%,P < 0.001）、DCBD患者51例（25%）和Du患者17例（58%,P < 0.001）。PH组87例患者的生存曲线差于DCBD组51例、Am组149例（P < 0.001）和Du组17例（P < 0.001）。Cox回归分析使用了11个影响预后的变量，结果显示静脉浸润、神经周围浸润、手术切缘和组织病理类型是影响预后的重要因素。胰腺癌具有更强的去分化组织病理性质，表现出更强的侵袭性生长，其预后比Am、DCBD和Du更差。
A total of 304 patients with pancreatoduodenal carcinoma were studied clinicopathologically and immunohistochemically in order to clarify features of carcinoma of four different sites of origin; carcinoma of the ampulla of Vater (Am), the distal common bile duct (DCBD), the head of the pancreas (PH), and the extra-ampullary duodenum (Du). The mean greatest diameter of 87 PH was 3.5 cm compared with 2.7 cm of 149 Am and 2.7 cm of DCBD. Histopathologically, 40% of Am were papillary adenocarcinoma, while about half of DCBD, PH and Du were tubular adenocarcinoma. PH invaded lymphatic (85%), vascular (62%), and perineural (95%) spaces and metastasized lymph nodes (72%) more frequently than Am (77%, 35%, 24%, 50%), DCBD (47%, 61%, 65%, 45%), and Du (76%, 29%, 35%, 65%), respectively. More than 50% of PH invaded the resected margins, whereas in only 2% of Am, the surgical margins were affected by malignant cells. Immunohistochemically, PH was more frequently positive for both carcinoembryonic antigen (CEA) (98%) and carbohydrate antigen (CA) 19-9 (91%) than Am (83%, 62%), DCBD (94%, 58%), and Du (56%, 11%), respectively. The stromal staining type of CEA and CA19-9 was more frequently seen in PH (27%, 44%) than in Am (9%, 31%), DCBD (11%, 8%) and Du (0%, 0%), showing a more dedifferentiated nature of PH. The cumulative 3-year survival rate of 87 patients with PH (15%) was worse than that of 149 with Am (42%, P < 0.001), of 51 with DCBD (25%) and of 17 with Du (58%, P < 0.001). The survival curve of 87 with PH was worse than that of 51 with DCBD, of 149 with Am (P < 0.001) and of 17 with Du (P < 0.001). Cox regression analysis, using eleven profound prognostic variables, revealed that venous invasion, perineural infiltration, surgical margin, and histopathologic type were profound pronostic factors. Pancreatic carcinoma has a more dedifferentiated histopathologic nature, showing a more aggressive growth and fares worse than Am, DCBD, and Du.