五种壶腹周围癌：并非只是不同的兄弟姐妹，而是不同的家族——一项国际多中心队列研究

The Five Periampullary Cancers, not Just Different Siblings but Different Families: An International Multicenter Cohort Study.

作者信息

Uijterwijk Bas A, Lemmers Daniël H, Ghidini Michele, Wilmink Hanneke, Zaniboni Alberto, Salvia Roberto, Kito Fusai Giuseppe, Groot Koerkamp Bas, Koek Sharnice, Ghorbani Poya, Zerbi Alessandro, Nappo Gennaro, Luyer Misha, Goh Brian K P, Roberts Keith J, Boggi Ugo, Mavroeidis Vasileios K, White Steven, Kazemier Geert, Björnsson Bergthor, Serradilla-Martín Mario, House Michael G, Alseidi Adnan, Ielpo Benedetto, Mazzola Michele, Jamieson Nigel, Wellner Ulrich, Soonawalla Zahir, Cabús Santiago Sánchez, Dalla Valle Raffaele, Pessaux Patrick, Vladimirov Miljana, Kent Tara S, Tang Chung N, Fisher William E, Kleeff Jorg, Mazzotta Alessandro, Suarez Muñoz Miguel Angel, Berger Adam C, Ball Chad G, Korkolis Dimitris, Bannone Elisa, Ferarri Clarissa, Besselink Marc G, Abu Hilal Mohammed

机构信息

Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Cancer Center Amsterdam, Amsterdam, The Netherlands.

出版信息

Ann Surg Oncol. 2024 Sep;31(9):6157-6169. doi: 10.1245/s10434-024-15555-8. Epub 2024 Jun 18.

DOI:10.1245/s10434-024-15555-8

PMID:38888860

Abstract

BACKGROUND

Cancer arising in the periampullary region can be anatomically classified in pancreatic ductal adenocarcinoma (PDAC), distal cholangiocarcinoma (dCCA), duodenal adenocarcinoma (DAC), and ampullary carcinoma. Based on histopathology, ampullary carcinoma is currently subdivided in intestinal (AmpIT), pancreatobiliary (AmpPB), and mixed subtypes. Despite close anatomical resemblance, it is unclear how ampullary subtypes relate to the remaining periampullary cancers in tumor characteristics and behavior.

METHODS

This international cohort study included patients after curative intent resection for periampullary cancer retrieved from 44 centers (from Europe, United States, Asia, Australia, and Canada) between 2010 and 2021. Preoperative CA19-9, pathology outcomes and 8-year overall survival were compared between DAC, AmpIT, AmpPB, dCCA, and PDAC.

RESULTS

Overall, 3809 patients were analyzed, including 348 DAC, 774 AmpIT, 848 AmpPB, 1,036 dCCA, and 803 PDAC. The highest 8-year overall survival was found in patients with AmpIT and DAC (49.8% and 47.9%), followed by AmpPB (34.9%, P < 0.001), dCCA (26.4%, P = 0.020), and finally PDAC (12.9%, P < 0.001). A better survival was correlated with lower CA19-9 levels but not with tumor size, as DAC lesions showed the largest size.

CONCLUSIONS

Despite close anatomic relations of the five periampullary cancers, this study revealed differences in preoperative blood markers, pathology, and long-term survival. More tumor characteristics are shared between DAC and AmpIT and between AmpPB and dCCA than between the two ampullary subtypes. Instead of using collective definitions for "periampullary cancers" or anatomical classification, this study emphasizes the importance of individual evaluation of each histopathological subtype with the ampullary subtypes as individual entities in future studies.

摘要

背景

壶腹周围区域发生的癌症在解剖学上可分为胰腺导管腺癌（PDAC）、远端胆管癌（dCCA）、十二指肠腺癌（DAC）和壶腹癌。基于组织病理学，壶腹癌目前分为肠型（AmpIT）、胰胆管型（AmpPB）和混合型。尽管在解剖结构上相似，但尚不清楚壶腹癌亚型在肿瘤特征和行为方面与其他壶腹周围癌有何关系。

方法

这项国际队列研究纳入了2010年至2021年间从44个中心（来自欧洲、美国、亚洲、澳大利亚和加拿大）检索到的接受了壶腹周围癌根治性切除的患者。比较了DAC、AmpIT、AmpPB、dCCA和PDAC之间的术前CA19-9、病理结果和8年总生存率。

结果

总体上，分析了3809例患者，包括348例DAC、774例AmpIT、848例AmpPB、1036例dCCA和803例PDAC。AmpIT和DAC患者的8年总生存率最高（分别为49.8%和47.9%），其次是AmpPB（34.9%，P<0.001）、dCCA（26.4%，P = 0.020），最后是PDAC（12.9%，P<0.001）。较好的生存率与较低的CA19-9水平相关，但与肿瘤大小无关，因为DAC病变的尺寸最大。

结论

尽管五种壶腹周围癌在解剖学上关系密切，但本研究揭示了术前血液标志物、病理和长期生存率方面的差异。DAC和AmpIT之间以及AmpPB和dCCA之间共享的肿瘤特征比两种壶腹癌亚型之间更多。本研究强调在未来研究中，将壶腹癌亚型作为独立个体对每种组织病理学亚型进行个体评估的重要性，而不是使用“壶腹周围癌”的集体定义或解剖学分类。