壶腹和胰腺腺癌的比较：较小的侵袭、常见的腺瘤成分、可切除性和组织学是提高壶腹腺癌患者生存率的因素。
Comparison of Ampullary and Pancreatic Adenocarcinomas: Smaller Invasion, Common Adenomatous Components, Resectability, and Histology are Factors for Improved Survival for Patients with Ampullary Adenocarcinoma.
发表日期：2024 Oct 14
作者：
Bahar Memis, Burcu Saka, Burcin Pehlivanoglu, Grace Kim, Serdar Balci, Takuma Tajiri, Nobuyuki Ohike, Pelin Bagci, Kadriye Ebru Akar, Takashi Muraki, Kee-Taek Jang, Shishir K Maithel, Juan Sarmiento, David A Kooby, Rohat Esmer, Zeynep Cagla Tarcan, Michael Goodman, Yue Xue, Alyssa Krasinskas, Michelle Reid, Olca Basturk, Volkan Adsay
来源：
ANNALS OF SURGICAL ONCOLOGY
摘要：
关于壶腹腺癌 (AC) 和胰腺腺癌 (PC) 之间的临床病理/结果差异的信息一直存在冲突，以至于人们仍然质疑是否需要将 AC 与 PC 分开。将 413 例 AC 的特征与其他腺癌的特征进行了比较547 例 PC。AC 的预后比 PC 更好（5 年生存率，57 % vs 23 %；p < 0.001）。即使胰胆 (PB) 型 AC 也有更好的预后（5 年生存率，46 % vs 23 %；p < 0.001）。几个差异也被确定为促成因素：(1) 浸润前腺瘤成分通常占 AC 肿块的很大一部分（> 50% 的肿瘤，16% 与 1.5%；p < 0.001）； (2) AC 中癌的平均尺寸更小（2.5 vs 3.2 cm；p < 0.001）：当与侵袭尺寸匹配时，AC 的生存优势被最小化，而当与大于 2 cm 的侵袭尺寸匹配时，AC 的生存优势被最小化。 AC的生存优势失去了统计学意义； (3) 淋巴结 (LN) 转移在 AC 中较少见（49 % vs 71 %；p < 0.001）； (4) AC 中的最终 R1 率较低（4% vs 23.5%；p < 0.001）； (5) 非 PB 和非管状腺癌类型在 AC 中更常见（17 % vs 3 %；p < 0.001）。相比之下，AC 比 PC 具有更好的临床生存率。潜在的影响因素包括浸润前成分的相对丰富、较小的侵袭、较低的淋巴结转移率、较高的可切除性以及常见的侵袭性较低的组织学表型（肠、髓质、粘液性）。然而，即使在 PB 型 AC 中，这种生存优势也得以维持，这凸显了准确确定起源部位的重要性。© 2024。外科肿瘤学会。
The information on the clinicopathologic/outcome differences between ampullary adenocarcinoma (AC) and pancreatic adenocarcinoma (PC) has been conflicting to the extent that it still is questioned whether ACs need to be recognized separately from PCs.The characteristics of 413 ACs were compared with those of 547 PCs.The ACs had a better prognosis than the PCs (5-year survival, 57 % vs 23 %; p < 0.001). Even the pancreatobiliary (PB)-type ACs had a better prognosis (5-year survival, 46 % vs 23 %; p < 0.001). Several differences also were identified as contributing factors: (1) the preinvasive adenomatous component often constituted a significant proportion of the mass in ACs (>50 % of the tumor in 16 % vs 1.5 %; p < 0.001); (2) the mean size of the carcinoma was smaller in ACs (2.5 vs 3.2 cm; p < 0.001): when matched for invasion size, the survival advantage of AC was minimized, and when matched for invasion size larger than 2 cm, the survival advantage of AC lost its statistical significance; (3) lymph node (LN) metastases were less common in ACs (49 % vs 71 %; p < 0.001); (4) the definitive R1 rate was lower in ACs (4 % vs 23.5 %; p < 0.001); and (5) non-PB and non-tubular adenocarcinoma types were more common in ACs (17 % vs 3 %; p < 0.001).Comparatively, ACs have better clinical survival than PCs. Potential contributing factors are the relative abundance of the preinvasive component, smaller invasion, lower LN metastasis rate, higher resectability, and common occurrence of less aggressive histologic phenotypes (intestinal, medullary, mucinous). However, this survival advantage is sustained even in PB-type ACs, highlighting the importance of accurately determining the site of origin.© 2024. Society of Surgical Oncology.