背景:淋巴结(LN)转移是手术切除的Vater壶腹(AoV)癌患者的既定预后因素。根治性切除术的标准程序,包括删除区域LN,是胰十二指肠切除术(PD);然而,对于有显著合并症的早期癌症患者,局部切除被认为是一种替代选择.在本研究中,我们阐明了与LN转移相关的术前因素,以确定T1AoV癌的适当手术范围。
方法:我们纳入了2000年至2019年在三星医学中心和Severance医院接受T1AoV癌症手术的患者。分析危险因素以确定与LN转移或随访期间区域LN复发相关的术前参数。最后,使用已识别的风险因素,建立了预测模型。
结果:在342名患者中,311名患者接受了PD,而31例患者接受了经十二指肠切除术。根据病理报告,48例患者有LN转移,2例患者出现局部LN复发。年龄,碳水化合物抗原19-9(CA19-9),和肿瘤分化被确定为与LN转移或局部LN复发风险增加相关的因素。具有这三个因素的预测模型的曲线下面积为0.728。
结论:我们新开发的使用年龄的预测模型,CA19-9和肿瘤分化可以帮助选择需要局部切除的PD患者。然而,对于推测为T1AoV癌患者选择合适的手术范围,我们需要进行额外的深入分析.
BACKGROUND: Lymph node (LN) metastasis is an established prognostic factor for patients with surgically resected ampulla of Vater (AoV) cancer. The standard procedure for radical resection, including removal of regional LNs, is pancreaticoduodenectomy (PD); however, local excision has been considered as an alternative option for patients in the early stage cancer with significant comorbidities. In the present study, we elucidated the preoperative factors associated with LN metastasis to determine the appropriate surgical extent for T1 AoV cancer.
METHODS: We included patients who underwent surgery for T1 AoV cancer at Samsung Medical Center and Severance Hospital between 2000 and 2019. Risk factors were analyzed to identify the preoperative parameters associated with LN metastasis or regional LN recurrence during follow-up. Finally, using the identified risk factors, a prediction model was constructed.
RESULTS: Among 342 patients, 311 patients underwent PD, whereas 31 patients underwent transduodenal ampullectomy. Fourty-eight patients had LN metastasis according to pathology report, and two patients presented with regional LN recurrence. Age, carbohydrate antigen 19 - 9 (CA 19 - 9), and tumor differentiation were identified as factors associated with the increased risk of LN metastasis or regional LN recurrence. The area under the curve of the prediction model with these three factors was 0.728.
CONCLUSIONS: Our newly developed prediction model using age, CA 19 - 9, and tumor differentiation can help select patients who require PD over local excision. Nevertheless, additional in-depth analysis is warranted to select appropriate surgical extent for patients with presumed T1 AoV cancer.