诊断学理论与实践 ›› 2022, Vol. 21 ›› Issue (03): 355-361.doi: 10.16150/j.1671-2870.2022.03.011
收稿日期:
2022-04-08
出版日期:
2022-06-25
发布日期:
2022-08-17
通讯作者:
王婷
E-mail:wangting_tina@126.com
LI Lei, YUAN Fei, WANG Chaofu, XU Haimin, WANG Ting()
Received:
2022-04-08
Online:
2022-06-25
Published:
2022-08-17
Contact:
WANG Ting
E-mail:wangting_tina@126.com
摘要:
目的:探讨壶腹部临床病理特征及预后特点。方法:统计2017年1月至2019年12月间上海交通大学医学院附属瑞金医院行胰十二指肠切除手术标本中壶腹部腺癌的占比,分析患者的临床资料和病理学特征,根据2019年第五版《世界卫生组织消化系统肿瘤分类》中新的组织学分类标准将壶腹部腺癌重新分类,并统计各组织类型占比,分析随访及临床资料,总结预后不良的危险因素。结果:本组胰十二指肠切除标本中,6.95%(101/1 454)经术后病理证实为壶腹部腺癌。患者中位发病年龄为64岁。男女比例为46∶55。组织学类型占比分别为:肠型腺癌占19.80%(20/101),胰胆管型腺癌占43.56%(44/101),管状腺癌占36.63%(37/101)。101例患者中26例失访,余75例患者的随访时间为1~45个月,中位随访时间是18个月,术后1年生存率为78.58%,2年生存率为67.40%。Log-rank生存分析显示非肠型腺癌组(胰胆管型腺癌和管状腺癌)较肠型腺癌组总体生存率低(P=0.0415);肿瘤细胞CK7阳性组较CK7阴性组总体生存率低(P=0.0425)。结论:壶腹部腺癌好发于老年人,无明显性别倾向;组织学类型以胰胆管型腺癌和管状腺癌为主,少数为肠型腺癌;非肠型腺癌、肿瘤细胞CK7阳性表达是患者预后不良的重要危险因素。
中图分类号:
李蕾, 袁菲, 王朝夫, 许海敏, 王婷. 101例壶腹部腺癌临床病理及预后因素分析[J]. 诊断学理论与实践, 2022, 21(03): 355-361.
LI Lei, YUAN Fei, WANG Chaofu, XU Haimin, WANG Ting. Ampullary adenocarcinoma: analysis of the clinicopathological features and prognostic factors[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 355-361.
表3
血清CA19-9与壶腹部腺癌临床病理学特点间的相关性[例(n)]
临床病理学特点 | 例数 | 血清CA19-9 | P值 | |
---|---|---|---|---|
正常 | 升高 | |||
性别 | 100 | 0.163 8 | ||
男 | 46 | 15 | 31 | |
女 | 54 | 25 | 29 | |
年龄(岁) | 100 | 0.623 6 | ||
≤64 | 53 | 20 | 33 | |
>64 | 47 | 20 | 27 | |
肿瘤组织学类型 | 100 | 0.307 4 | ||
肠型 | 20 | 10 | 10 | |
非肠型 | 80 | 30 | 50 | |
肿瘤分化程度 | 100 | 0.741 5 | ||
高-中分化 | 43 | 18 | 25 | |
低分化 | 57 | 22 | 35 | |
肿瘤最大径(cm) | 100 | 0.246 9 | ||
≤2.5 | 58 | 26 | 32 | |
>2.5 | 42 | 14 | 28 | |
肿瘤浸润深度 | 100 | 0.002 7 | ||
T1~T2 | 35 | 21 | 14 | |
T3 | 65 | 19 | 46 | |
神经侵犯 | 100 | 0.325 6 | ||
是 | 46 | 16 | 30 | |
否 | 54 | 24 | 30 | |
淋巴结转移 | 100 | 0.041 2 | ||
是 | 50 | 15 | 35 | |
否 | 50 | 25 | 25 |
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