Jaundice at presentation heralds advanced disease and poor prognosis in patients with ampullary carcinoma
Jaundice at presentation heralds advanced disease and poor prognosis in patients with ampullary carcinoma
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DOI：
10.1007/s00268-004-7709-5
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发表时间：
2005-04-01
影响因子：
2.6
通讯作者：
Hatakeyama, K
中科院分区：
文献类型：
--
作者：
Yokoyama, N;Shirai, Y;Hatakeyama, K
黄疸是壶腹癌的常见表现。本研究的目的是评估初始黄疸与肿瘤扩散程度的相关性，并确定黄疸在壶腹癌患者中的预后意义。回顾性分析59例壶腹癌根治性手术的临床资料。黄疸定义为血清总胆红素浓度>= 3 mg/dl。中位随访时间为106个月。43例（73%）患者首次出现黄疸。表现时黄疸与淋巴结转移（p < 0.0001）、淋巴管侵犯（p < 0.0001）、胰腺侵犯（p = 0.0007）和血管侵犯（p = 0.0487）相关。无黄疸患者无胰腺侵犯。黄疸患者的肠系膜上结受累发生率（15143）高于无黄疸患者（0/16）（p = 0.0062）。黄疸患者的生存期（中位生存期48个月，累积10年生存率39%）低于无黄疸患者（中位生存期不详，累积10年生存率86%）（p = 0.0014）。总之，出现黄疸预示着晚期壶腹癌和不良预后。在非黄疸患者中未观察到胰腺侵犯和肠系膜上淋巴结受累。
Jaundice is a common manifestation of ampullary carcinoma. The aim of this study was to evaluate the correlation between jaundice at initial presentation and the degree of tumor spread and to determine the prognostic significance of jaundice in patients with ampullary carcinoma. Fifty-nine patients who had undergone curative resection for ampullary carcinoma were analyzed retrospectively. Jaundice was defined as a total bilirubin serum concentration of >= 3 mg/dl. The median follow-up time was 106 months. Jaundice was noted at the time of initial presentation in 43 (73%) patients. Jaundice at presentation correlated with lymph node metastasis (p < 0.0001), lymphatic vessel invasion (p < 0.0001), invasion into the pancreas (p = 0.0007), and vascular invasion (p = 0.0487). Pancreatic invasion was absent in patients without jaundice. Superior mesenteric nodal involvement was more frequent in patients with jaundice (15143) than in those without (0/16) (p = 0.0062). The survival of patients with jaundice (median survival 48 months; cumulative 10-year survival rate 39%) was worse than for patients without jaundice (median survival time not available; cumulative 10-year survival rate 86%) (p = 0.0014). In conclusion, jaundice at presentation predicts advanced-stage ampullary carcinoma and a poor prognosis. Pancreatic invasion and superior mesenteric nodal involvement were not observed in non-jaundiced patients.