黄疸前期壶腹周围癌的临床病理特征及预后分析

彭孝倩; 刘璐; 焦笑笑; 周琳

doi:10.3969/j.issn.1001-5256.2019.12.022

黄疸前期壶腹周围癌的临床病理特征及预后分析

DOI: 10.3969/j.issn.1001-5256.2019.12.022

郑州大学第一附属医院消化内科

基金项目:

国家自然科学基金(81001103,81472325)；

详细信息

中图分类号: R735.0
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出版历程
- 收稿日期: 2019-07-19
- 出版日期: 2019-12-20

Clinicopathological features and prognosis of periampullary carcinomas in the pre-jaundice stage

Department of Gastroenterology,The First Affiliated Hospital of Zhengzhou University

Research funding:

摘要

摘要: 目的探讨黄疸前期壶腹周围癌（PACs）的临床病理特征及预后因素。方法回顾性分析2012年1月-2017年12月收治的518例PACs的病例资料,根据入院时黄疸症状及血清TBil水平分为黄疸前期组（125例）与黄疸型组（393例）。对比两组临床资料、病理特征及5年生存率的差异并分析预后因素。计量资料服从正态分布时,两组间比较采用独立样本t检验;不服从正态分布时,两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ2检验。采用Kaplan-Meier法计算患者生存率并绘制生存曲线,采用log-rank检验法进行单因素分析,Cox比例风险回归模型进行多因素分析。结果与黄疸型组相比,黄疸前期组患者表现为腹部胀痛的比例更高,持续时间更长,RBC、Alb、PA水平均明显升高,差异均有统计学意义（χ2=14. 786,Z=-6. 023,t值分别为-2. 247、-4. 688、-3. 873,P值均<0. 05）;黄疸前期组ALT、AST、GGT、ALP均明显低于黄疸型组,差异均有统计学意义（Z值分别为-75. 647、-55. 567、-52. 583、-61. 501...
- 肝胰管壶腹 /
- 消化系统肿瘤 /
- 黄疸 /
- 病理状态,体征和症状 /
- 预后
Abstract: Objective To investigate the clinicopathological features and prognostic factors of periampullary carcinomas( PACs) in the pre-jaundice stage. Methods A retrospective analysis was performed for the clinical data of 518 patients with PACs who were admitted from January 2012 to December 2017,and according to jaundice symptom and serum total bilirubin on admission,they were divided into pre-jaundice group with 125 patients and jaundice group with 393 patients. The two groups were compared in terms of clinical data,pathological features,and 5-year survival rate,and prognostic factors were analyzed. The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to calculate survival rates and plot survival curves. The log-rank test was used for univariate analysis,and the Cox proportional-hazards regression model was used for multivariate analysis. Results Compared with the jaundice group,the pre-jaundice group had a significantly higher proportion of patients with the manifestation of abdominal distension and pain,a significantly longer duration of abdominal distension and pain,and significant increases in red blood cell count,albumin,and prealbumin( χ2= 14. 786,Z =-6. 023,t =-2. 247,-4. 688,and-3. 873,all P < 0. 05),as well as significantly lower alanine aminotransferase,aspartate aminotransferase,gamma-glutamyl transpeptidase,and alkaline phosphatase( Z =-75. 647,-55. 567,-52. 583,and-61. 501,all P < 0. 05). The detection rates of space-occupying lesions by ultrasound,computed tomography,magnetic resonance imaging/magnetic resonance cholangiopancreatography,and endoscopic retrograde cholangiopancreatography were 45. 0%,77. 7%,79. 2%,and 100%,respectively. As for pathology,compared with the jaundice group,the pre-jaundice group had a significantly longer mean tumor diameter,a significant difference in the proportion of patients with different primary sites,and significantly lower T stage and positive rate of pancreatic invasion( Z =-3. 063,χ2=10. 641,3. 991,and 4. 708,all P < 0. 05). The pre-jaundice group had a significantly higher 5-year survival rate than the jaundicegroup( χ2= 4. 582,P < 0. 05). The multivariate analysis showed that intravascular tumor thrombus,degree of tumor differentiation,and adjuvant chemotherapy were independent influencing factors for the prognosis of PACs. Conclusion PACs patients in the pre-jaundice stage has better clinicopathological features and long-term( ≥5 years) survival rate than those with jaundice,and therefore,early identification,diagnosis,and treatment can improve the survival rate of patients with PACs.
- ampulla of vater /
- digestive system neoplasms /
- jaundice /
- pathological conditions,signs and symptoms /
- prognosis

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参考文献(20)

[1] EL N,EL SM,EZZAT H,et al. Predictors of long-term survival after pancreaticoduodenectomy for peri-ampullary adenocarcinoma:A retrospective study of 5-year survivors[J].Hepatobiliary pancreat Dis Int,2018,17(5):443-449.

[2] YIN T,ZHOU YK,WU HS. Diagnosis and treatment of ampullary tumors[J]. J Clin Hepatol,2017,33(2):268-271.(in Chinese)殷涛，周颖珂，吴河水．壶腹部肿瘤的诊断和治疗[J]．临床肝胆病杂志，2017,33(2):268-271.

[3] KAMISAWA T,TU Y,EGAWA N,et al. Clinicopathologic features of ampullary carcinoma without jaundice[J]. J Clin Gastroenterol,2006,40(2):162-166.

[4] YAMAGUCHI K,ENJOJI M,KITAMURA K. Non-icteric ampullary carcinoma with a favorable prognosis[J]. Am J Gastroenterol,1990,85(8):994-999.

[5] YOKOYAMA N,SHIRAI Y,WAKAI T,et al. Jaundice at presentation heralds advanced disease and poor prognosis in patients with ampullary carcinoma[J]. World J Surg,2005,29(4):519-523.

[6] STRASBERG SM,GAO F,SANFORD D,et al. Jaundice:An important,poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas[J]. HPB(Oxford),2014,16(2):150-156.

[7] AMIN MB,EDGE S,GREENE FL,et al. AJCC Cancer Staging Manual[M]. 8th ed. New York:Springer,2016.

[8] NAKATA B,AMANO R,KIMURA K,et al. Comparison of prognosis between patients of pancreatic head cancer with and without obstructive jaundice at diagnosis[J]. Int J Surg,2013,11(4):344-349.

[9] CHEN SC,SHYR YM,WANG SE. Long term survival after pancreaticoduodenectomy for periampullary adenocarcinomas[J].HPB(Oxford),2013,15(12):951-957.

[10] ZHEN GH,AI KX,WANG Y. Diagnosis of periampullary carcinoma without jaundice[J]. J Hepatopancreatobiliary Surg,2005,17(4):51-52.(in Chinese)甄戈华，艾开兴，汪昱．无黄疸型壶腹周围癌的诊断体会[J]．肝胆胰外科杂志，2005,17(4):51-52.

[11] TANG HH,CHANG S. Diagnosis and treatment of extrahepatic bile duct carcinoma without jaundice[J]. Chin J Hepatobiliary Surg,2001,7(2):79-81.(in Chinese)汤辉焕，常实．无黄疸期肝外胆管癌的诊治体会[J]．中华肝胆外科杂志，2001,7(2):79-81.

[12] ZHAO YP. Early and differential diagnosis of periampullary cancer[J]. Chin J Dig Surg,2008,7(6):401-403.(in Chinese)赵玉沛．壶腹周围癌早期诊断和鉴别诊断[J]．中华消化外科杂志，2008,7(6):401-403.

[13] ZHU SJ,LU YH,ZHU MY,et al. Diagnosis and treatment of176 cases of periampullary carcinoma[J]. J Hepatopancreatobiliary Surg,2008,20(3):195-197.(in Chinese)朱沙俊，陆玉华，朱铭岩，等．壶腹部周围癌176例诊治分析[J]．肝胆胰外科杂志，2008,20(3):195-197.

[14] WALSH RM,CONNELLY M,BAKER M. Imaging for the diagnosis and staging of periampullary carcinomas[J]. Surg Endosc,2003,17(10):1514-1520.

[15] SUN KK,HU PP,XU F,et al. Comparative study of endoscopic ultrasonography and CT in the diagnosis of patients with pancreatic and periampullary tumors[J]. Chin J Prim Med Pharm,2018,25(15):1918-1921.(in Chinese)孙柯科，胡萍萍，许丰，等．超声内镜与CT检查对胰腺及壶腹部周围肿瘤诊断价值的比较[J]．中国基层医药，2018,25(15):1918-1921.

[16] LIANG YM,WANG T,SUN QL,et al. A comparison of the clinical features and prognosis of pancreatic head cancer with that of other periampullary cancers[J]. Hepatogastroenterology,2013,60(124):864-869.

[17] ACHARYA A,MARKAR SR,SODERGREN MH,et al. Metaanalysis of adjuvant therapy following curative surgery for periampullary adenocarcinoma[J]. Br J Surg,2017,104(7):814-822.

[18] SARMIENTO JM,NAGOMEY DM,SARR MG,et al. Periampullary cancers:Are there differences?[J]. Surg Clin North Am,2001,81(3):543-555.

[19] BAGHMAR S,AGRAWAL N,KUMAR G,et al. Prognostic factors and the role of adjuvant treatment in periampullary carcinoma:A single-centre experience of 95 patients[J]. J Gastrointest Cancer,2019,50(3):361-369.

[20] KRISHNAN S,RANA V,EVANS DB,et al. Role of adjuvant chemoradiation therapy in adenocarcinomas of the ampulla of vater[J]. Int J Radiat Oncol Biol Phys,2008,70(3):735-743.

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