黄疸前期壶腹周围癌的临床病理特征及预后分析  

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

作　　者：彭孝倩 刘璐[1] 焦笑笑 周琳[1] PENG Xiaoqian;LIU Lu;JIAO Xiaoxiao;et al(Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第一附属医院消化内科

出　　处：《临床肝胆病杂志》2019年第12期2748-2753,共6页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81001103,81472325)

摘　　要：目的探讨黄疸前期壶腹周围癌(PACs)的临床病理特征及预后因素。方法回顾性分析2012年1月-2017年12月收治的518例PACs的病例资料,根据入院时黄疸症状及血清TBil水平分为黄疸前期组(125例)与黄疸型组(393例)。对比两组临床资料、病理特征及5年生存率的差异并分析预后因素。计量资料服从正态分布时,两组间比较采用独立样本t检验;不服从正态分布时,两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ2检验。采用Kaplan-Meier法计算患者生存率并绘制生存曲线,采用log-rank检验法进行单因素分析,Cox比例风险回归模型进行多因素分析。结果与黄疸型组相比,黄疸前期组患者表现为腹部胀痛的比例更高,持续时间更长,RBC、Alb、PA水平均明显升高,差异均有统计学意义(χ^2=14.786,Z=-6.023,t值分别为-2.247、-4.688、-3.873,P值均<0.05);黄疸前期组ALT、AST、GGT、ALP均明显低于黄疸型组,差异均有统计学意义(Z值分别为-75.647、-55.567、-52.583、-61.501,P值均<0.05)。B超、CT、MRI/磁共振胰胆管造影、经内镜逆行胰胆管造影对于黄疸前期组的占位检出率分别为45.0%、77.7%、79.2%、100%。病理学方面,黄疸前期组的肿瘤直径更大,各原发部位所占比例不同,T分期及胰腺侵犯阳性率更低(Z=-3.063,χ^2值分别为10.641、3.991、4.708,P值均<0.05)。黄疸前期组5年生存率高于黄疸型组(χ^2=4.582,P<0.05)。多因素分析结果提示,脉管内癌栓、分化程度和辅助化疗是PACs独立预后影响因素(P值均<0.05)。结论黄疸前期PACs患者的临床病理特征及长期生存率(≥5年)优于黄疸型,早期识别、诊断及治疗可提高PACs的生存率。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(χ^2=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 diam

关 键 词：肝胰管壶腹 消化系统肿瘤 黄疸 病理状态 体征和症状 预后 

分 类 号：R735[医药卫生—肿瘤]