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

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.