胰周癌患者的肿瘤起源、诊断准确性和组织病理学评估：全国性队列研究。
Tumour origin, diagnostic accuracy and histopathological evaluation in patients with periampullary cancer: nationwide cohort study.
机构信息
Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
Department of Clinical Pathology/Cytology, Division of Pathology, Karolinska University Hospital, Huddinge, Sweden.
出版信息
BJS Open. 2023 Sep 5;7(5). doi: 10.1093/bjsopen/zrad104.
BACKGROUND
The prevalence of different periampullary cancers (pancreatic ductal adenocarcinoma, distal cholangiocarcinoma, ampullary cancer and duodenal cancer) is heterogeneous in the literature. During the 2010s, a standardized histopathological protocol for pancreatoduodenectomy specimens based on axial slicing was adopted in Sweden. The present study sought to provide information about periampullary cancers with regard to tumour types in curative and noncurative settings, preoperative diagnostic accuracy and the impact of a standardized evaluation of the surgical specimen on diagnosis, R status and lymph node assessment.
METHODS
Data from patients diagnosed with periampullary cancer from 2010 to 2019 were retrieved from the Swedish National Registry for Pancreatic and Periampullary Cancer.
RESULTS
Among non-curative patients, 3704 (83.6 per cent) were diagnosed with pancreatic ductal adenocarcinoma. Among patients treated with pancreatoduodenectomy, diagnosis was pancreatic ductal adenocarcinoma in 1380 (50.0 per cent), distal cholangiocarcinoma in 284 (10.3 per cent), ampullary cancer in 376 (13.6 per cent), duodenal cancer in 160 (5.8 per cent) and other diagnoses in 560 (20.3 per cent) patients. The preoperative diagnosis corresponded to the postoperative in 1177 (67.5 per cent) patients for pancreatic ductal adenocarcinoma, 162 (37.4 per cent) patients for distal cholangiocarcinoma, 220 (61.3 per cent) patients for ampullary cancer and 120 (53.6 per cent) patients for duodenal cancer. A higher rate of pancreatic ductal adenocarcinoma was seen in surgical specimens who underwent standardized evaluation, from 56.8 per cent to 64.3 per cent (P = 0.003). After standardization, higher rates of R1 resection (31.7 per cent versus 44.6 per cent, P < 0.001) and N1 stage (62.1 per cent versus 77.0 per cent, P < 0.001) were found.
CONCLUSION
The proportion of pancreatic ductal adenocarcinoma was higher in patients in a non-curative setting compared with patients who underwent surgery. The rate of misdiagnosis for periampullary cancers was confirmed to be high. Thus, it should be taken into account when preoperative oncological treatment is considered. Standardized evaluation of the surgical specimen has increased pancreatic ductal adenocarcinoma, R1 and N1 rates.
背景
不同的壶腹周围癌（胰管腺癌、远端胆管癌、壶腹癌和十二指肠癌）在文献中的流行率存在差异。在 2010 年代，瑞典采用了一种基于轴向切片的胰十二指肠切除术标本的标准化组织病理学方案。本研究旨在提供有关壶腹周围癌的信息，包括在根治性和非根治性环境下的肿瘤类型、术前诊断准确性以及对手术标本进行标准化评估对诊断、R 状态和淋巴结评估的影响。
方法
从瑞典胰胆管癌国家登记处检索了 2010 年至 2019 年期间诊断为壶腹周围癌的患者数据。
结果
在非根治性患者中，3704 例（83.6%）诊断为胰管腺癌。在接受胰十二指肠切除术治疗的患者中，1380 例（50.0%）诊断为胰管腺癌，284 例（10.3%）诊断为远端胆管癌，376 例（13.6%）诊断为壶腹癌，160 例（5.8%）诊断为十二指肠癌，560 例（20.3%）诊断为其他诊断。胰管腺癌的术前诊断与术后诊断相符的患者有 1177 例（67.5%），远端胆管癌的术前诊断与术后诊断相符的患者有 162 例（37.4%），壶腹癌的术前诊断与术后诊断相符的患者有 220 例（61.3%），十二指肠癌的术前诊断与术后诊断相符的患者有 120 例（53.6%）。接受标准化评估的胰管腺癌手术标本中，胰管腺癌的检出率从 56.8%上升至 64.3%（P=0.003）。标准化后，R1 切除率（31.7%比 44.6%，P<0.001）和 N1 期（62.1%比 77.0%，P<0.001）均升高。
结论
在非根治性环境下的患者中，胰管腺癌的比例高于接受手术治疗的患者。壶腹周围癌的误诊率被证实很高。因此，在考虑术前肿瘤治疗时应考虑到这一点。手术标本的标准化评估增加了胰管腺癌、R1 和 N1 率。
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