Vater壶腹部腺癌的病理分型及临床特征分析  

Pathological typing and clinical features of Vater ampullary adenocarcinoma

作　　者：冯永恒 郑泽群 刘霜月 赵有才 杨坤兴[1] 席鹏程[1] FENG Yongheng;ZHENG Zequn;LIU Shuangyue(Department of General Surgery, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)普外科,南京210006 [2]南京医科大学附属南京医院(南京市第一医院)病理科,南京210006

出　　处：《临床肝胆病杂志》2020年第5期1104-1108,共5页Journal of Clinical Hepatology

基　　金：南京市医学科技发展项目(一般性课题)(YKK16131)。

摘　　要：目的探讨Vater壶腹部腺癌不同病理分型特征及其相关临床资料特点,分析影响其预后的临床因素,以期提高Vater壶腹部腺癌术后的预后评估和治疗效果。方法回顾性分析2010年1月-2017年1月南京医科大学附属南京医院(南京市第一医院)收治的65例Vater壶腹部腺癌病例资料,并依据病理HE染色对所有病例进行亚型分组,分为肠型组、胰胆型组和混合型组。应用免疫组织化学的方法研究肿瘤蛋白标志物MUC1、MUC2、CK7、CK20及CDX2在各亚型癌组织中的表达情况,同时对各组间的临床资料和预后结局进行比较分析。计数资料多组间比较采用χ2检验,计量资料多组间比较采用方差分析,选择Kaplan-Meier法绘制生存曲线并计算生存率。结果所选病例中包括肠型20例,胰胆管型34例和混合型11例。分析3组病例的免疫组化结果显示,肠型组中CDX2、CK20和MUC2阳性表达率明显高于胰胆型组(100%vs 2.94%,85.00%vs 0,55.00%vs 14.71%)(χ2值分别为49.916、42.178、9.806,P值均<0.01),而胰胆型组CK7及MUC1的阳性率显著高于肠型组(97.06%vs 20.00%,94.12%vs 5.00%)(χ2值分别为34.665、42.082,P值均<0.01)。混合型组常存在多种肿瘤标志物的共表达,且各标志物的阳性表达与其余两组比较,差异无统计学意义(P值均>0.05)。3组病例临床资料的比较结果显示,各亚型患者的年龄、性别以及肿瘤组织直径、组织分化程度和肿瘤TNM分期比较,差异均无统计学意义(P值均>0.05)。预后分析提示:3组的术后中位生存期分别为64.00、49.50和56.00个月,组间比较结果提示肠型组的5年生存率和5年无病生存率均明显优于胰胆型(60.00%vs 32.35%,55.00%vs 23.53%)(χ2值分别为5.206、6.140,P值分别为0.023、0.013),混合型介于二者之间,但差异均无统计学意义(P值均>0.05)。结论不同病理亚型的Vater壶腹部腺癌组织中MUC1、MUC2、CK7、CK20及CDX2的表达具有不同的特点,联合测定以上5种肿Objective To investigate the features and clinical data of different pathological types of Vater ampullary adenocarcinoma and the influencing factors for prognosis,and to improve the prognostic evaluation and treatment outcome of Vater ampullary adenocarcinoma after surgery.Methods A retrospective analysis was performed for the clinical data of 65 patients with Vater ampullary adenocarcinoma who were admitted to Nanjing First Hospital,namely Nanjing Hospital Affiliated to Nanjing Medical University,from January 2010 to January 2017,and the patients were divided into intestinal-type group,pancreaticobiliary-type group,and mixed-type group according to the results of HE staining.Immunohistochemistry was used to measure the expression of the tumor protein markers MUC1,MUC2,CK7,CK20,and CDX2 in the cancer tissue of various subtypes,and related clinical data and prognosis were compared and analyzed.The chi-square test was used for comparison of categorical data between groups;an analysis of variance was used for comparison of continuous data between groups;the Kaplan-Meier method was used to plot survival curves and calculate survival rates.Results Of all patients,20 had intestinal type,34 had pancreaticobiliary type,and 11 had mixed type.The results of immunohistochemistry showed that the intestinal-type group had significantly higher positive expression rates of CDX2,CK20,and MUC2 than the pancreaticobiliary-type group(100%/85.00%/55.00%vs 2.94%/0/14.71%,χ2=49.916,42.178,and 9.806,all P<0.01),and compared with the intestinal-type group,the pancreaticobiliary-type group had significantly higher positive rates of CK7(97.06%vs 20.00%,χ2=34.665,P<0.01)and MUC1(94.12%vs 5.00%,χ2=42.082,P<0.01).The patients in the mixed-type group often had co-expression of various tumor markers,and there were no significant differences in the positive expression of such markers between this group and the other two groups(all P>0.05).The comparison of clinical data between the three groups showed that there were no significant differen

关 键 词：肝胰管壶腹 腺癌 疾病特征 预后 

分 类 号：R735[医药卫生—肿瘤]