Vater壶腹部腺癌的病理分型及临床特征分析

冯永恒; 郑泽群; 刘霜月; 赵有才; 杨坤兴; 席鹏程

doi:10.3969/j.issn.1001-5256.2020.05.030

Vater壶腹部腺癌的病理分型及临床特征分析

DOI: 10.3969/j.issn.1001-5256.2020.05.030

1. 南京医科大学附属南京医院(南京市第一医院)普外科
2. 南京医科大学附属南京医院(南京市第一医院)病理科

基金项目:

南京市医学科技发展项目（一般性课题）（YKK16131）；

详细信息

中图分类号: R735.0
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出版历程
- 出版日期: 2020-05-20

Pathological typing and clinical features of Vater ampullary adenocarcinoma

Department of General Surgery, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China

Research funding:

摘要

摘要:
目的探讨Vater壶腹部腺癌不同病理分型特征及其相关临床资料特点,分析影响其预后的临床因素,以期提高Vater壶腹部腺癌术后的预后评估和治疗效果。方法回顾性分析2010年1月-2017年1月南京医科大学附属南京医院（南京市第一医院）收治的65例Vater壶腹部腺癌病例资料,并依据病理HE染色对所有病例进行亚型分组,分为肠型组、胰胆型组和混合型组。应用免疫组织化学的方法研究肿瘤蛋白标志物MUC1、MUC2、CK7、CK20及CDX2在各亚型癌组织中的表达情况,同时对各组间的临床资料和预后结局进行比较分析。计数资料多组间比较采用χ2检验,计量资料多组间比较采用方差分析,选择Kaplan-Meier法绘制生存曲线并计算生存率。结果所选病例中包括肠型20例,胰胆管型34例和混合型11例。分析3组病例的免疫组化结果显示,肠型组中CDX2、CK20和MUC2阳性表达率明显高于胰胆型组（100%vs 2. 94%,85. 00%vs 0,55. 00%vs 14. 71%）（χ2值分别为49916、42. 178、9. 806,P值均<0. 01）,...
- 肝胰管壶腹 /
- 腺癌 /
- 疾病特征 /
- 预后
Abstract:
Objective To investigate the features and clinical data of different pathological types of Vater ampullary adenocarcinoma and the influencing factors for prognosis, and to improve the prognostic evaluation and treatment outcome of Vater ampullary adenocarcinoma after surgery.Methods A retrospective analysis was performed for the clinical data of 65 patients with Vater ampullary adenocarcinoma who were admitted to Nanjing First Hospital, namely Nanjing Hospital Affiliated to Nanjing Medical University, from January 2010 to January 2017,and the patients were divided into intestinal-type group, pancreaticobiliary-type group, and mixed-type group according to the results of HE staining. Immunohistochemistry was used to measure the expression of the tumor protein markers MUC1, MUC2, CK7, CK20, and CDX2 in the cancer tissue of various subtypes, and related clinical data and prognosis were compared and analyzed. The chi-square test was used for comparison of categorical data between groups; an analysis of variance was used for comparison of continuous data between groups; the Kaplan-Meier method was used to plot survival curves and calculate survival rates.Results Of all patients, 20 had intestinal type, 34 had pancreaticobiliary type, and 11 had mixed type. The results of immunohistochemistry showed that the intestinal-type group/5500% vs 2.94%/0/14.71%,χ2= 49. 916, 42. 178, and 9. 806, allP< 0. 01), and compared with the intestinal-type group, the pancreaticobiliary-type group had significantly higher positive rates of CK7(97. 06% vs 20. 00%, χ2 =34.665,P< 0. 01) and MUC1(94.12% vs 5.00%,χ2 =42.082,P< 0. 01). The patients in the mixed-type group often had co-expression of various tumor markers,and there were no significant differences in the positive expression of such markers between this group and the other two groups(allP>05). The comparison of clinical data between the three groups showed that there were no significant differences in age, sex, tumor tissue diameter, degree of tumor differentiation, and TNM stage between the patients with different subtypes(allP> 0. 05). The prognostic analysis showed that the median survival time after surgery in the three groups was 64. 00 months, 49. 50 months, and 56. 00 months, respective-ly. The results of comparison between groups showed that the intestinal-type group had significantly higher 5-year survival rate and 5-year disease-free survival rate than the pancreaticobiliary-type group(5-year survival rate: 60. 00% vs 32. 35%,χ2= 5. 206,P=0. 023; 5-year disease-free survival rate: 55. 00% vs 23. 53%,χ2 =6.140,P= 0. 013), and the mixed-type group had lower 5-yearsurvival rate and 5-year disease-free survival rate than the intestinal-type group but higher 5-year survival rate and 5-year disease-free survival rate than the pancreaticobiliary-type group(allP> 0. 05).Conclusion Different pathological subtypes of Vater ampullaryadenocarcinoma have different features of the expression of MUC1, MUC2, CK7, CK20, and CDX2, and combined measurement of thesefive tumor protein markers can better identify the pathological type of Vater ampullary adenocarcinoma and thus assist in prognostic evaluationand postoperative treatment.
- ampulla of Vater /
- adenocarcinoma /
- disease attributes /
- prognosis

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参考文献(23)

[1] AHN DH, BEKAII-SAAB T. Ampullary cancer:An overview[J]. Am Soc Clin Oncol Educ Book, 2014, 34:112-115.

[2] CHUN YS, PAWLIK TM, VAUTHEY JN. 8th edition of the AJCC cancer staging manual:Pancreas and hepatobiliary cancers[J].Ann Surg Oncol, 2018, 25(4):845-847.

[3] ZIMMERMANN C, WOLK S, AUST DE, et al. The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma[J]. Sci Rep, 2019, 9(1):12676.

[4] ADSAY NV, BAGCI P, TAJIRI T, et al. Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers:Pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement[J]. Semin Diagn Pathol, 2012, 29(3):127-141.

[5] 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.

[6] KOHLER I, JACOB D, BUDZIES J, et al. Phenotypic and genotypic characterization of carcinomas of the papilla of Vater has prognostic and putative therapeutic implications[J].Am J Clin Pathol, 2011, 135(2):202-211.

[7] MORINI S, PERRONE G, BORZOMATI D, et al. Carcinoma of the ampulla of Vater:Morphological and immunophenotypical classification predicts overall survival[J]. Pancreas, 2013, 42(1):60-66.

[8] HARTHIMMER MR, STOLBORG U, PFEIFFER P, et al. Mutational profiling and immunohistochemical analysis of a surgical series of ampullary carcinomas[J]. J Clin Pathol, 2019, 72(11):762-770.

[9] KIMURA W, FUTAKAWA N, YAMAGATA S, et al. Different clinicopathologic findings in two histologic types of carcinoma of papilla of Vater[J]. Jpn J Cancer Res, 1994, 85(2):161-166.

[10] CHUNG YE, KIM MJ, PARK MS, et al. Differential features of pancreatobiliary-and intestinal-type ampullary carcinomas at MR imaging[J]. Radiology, 2010, 257(2):384-393.

[11] CHAI J, WANG YT, JIE KR, et al. Imaging features of intestinal-type and pancreaticobiliary-type invasive adenocarcinoma of the ampullary region[J]. Chin J Dig Surg, 2016, 15(4):395-400.(in Chinese）柴瑾，王玉涛，颉克蓉，等．肠型与胰胆管型壶腹部浸润性腺癌的影像学特征[J]．中华消化外科杂志，2016, 15(4):395-400.

[12] XUE Y, REID MD, BALCI S, et al. Immunohistochemical classification of ampullary carcinomas:Critical reappraisal fails to confirm prognostic relevance for recently proposed panels,and highlights MUC5AC as a strong prognosticator[J]. Am J Surg Pathol, 2017, 41(7):865-876.

[13] LIU F, SHEN D, MA Y, et al. Identification of ampullary carcinoma mixed subtype using a panel of six antibodies and its clinical significance[J]. J Surg Oncol, 2019, 119(3):295-302.

[14] KUMARI N, PRABHA K, SINGH RK, et al. Intestinal and pancreatobiliary differentiation in periampullary carcinoma:The role of immunohistochemistry[J]. Hum Pathol, 2013, 44(10):2213-2219.

[15] HEINRICH S, CLAVIEN PA. Ampullary cancer[J]. Curr Opin Gastroenterol, 2010, 26(3):280-285.

[16] ADSAY V, OHIKE N, TAJIRI T, et al. Ampullary region carcinomas:Definition and site specific classification with delineation of four clinicopathologically and prognostically distinct subsets in an analysis of 249 cases[J]. Am J Surg Pathol,2012, 36(11):1592-1608.

[17] REID MD, BALCI S, OHIKE N, et al. Ampullary carcinoma is often of mixed or hybrid histologic type:An analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases[J]. Mod Pathol, 2016,29(12):1575-1585.

[18] COLUSSI O, VORON T, POZET A, et al. Prognostic score for recurrence after Whipple’s pancreaticoduodenectomy for ampullary carcinomas; results of an AGEO retrospective multicenter cohort[J]. Eur J Surg Oncol, 2015, 41(4):520-526.

[19] KIM WS, CHOI DW, CHOI SH, et al. Clinical significance of pathologic subtype in curatively resected ampulla of vater cancer[J]. J Surg Oncol, 2012, 105(3):266-272.

[20] de PAIVA HADDAD LB, PATZINA RA, PENTEADO S, et al.Lymph node involvement and not the histophatologic subtype is correlated with outcome after resection of adenocarcinoma of the ampulla of vater[J]. J Gastrointest Surg, 2010, 14(4):719-728.

[21] KWON J, KIM BH, KIM K, et al. Survival benefit of adjuvant chemoradiotherapy in patients with ampulla of vater cancer:A systematic review and meta-analysis[J]. Ann Surg, 2015,262(1):47-52.

[22] PERYSINAKIS I, MARGARIS I, KOURAKLIS G. Ampullary cancer—a separate clinical entity?[J]. Histopathology, 2014, 64(6):759-768.

[23] WESTGAARD A, POMIANOWSKA E, CLAUSEN OP, et al. Intestinal-type and pancreatobiliary-type adenocarcinomas:How does ampullary carcinoma differ from other periampullary malignancies?[J]. Ann Surg Oncol, 2013, 20(2):430-439.

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