Population-Based Cohort Study on Treatment and Overall Survival of Patients Clinically Diagnosed With T1 Ampullary Cancer.

IF 7.5 1区 医学 Q1 SURGERY
Anouk J de Wilde, Evelien J M de Jong, Marco J Bruno, Marc G Besselink, Lydia G M van der Geest, Sandra M E Geurts, Bas Groot Koerkamp, Ignace H J T de Hingh, Vincent E de Meijer, Razvan L Miclea, Jan-Werner Poley, Iryna V Samarska, Hjalmar C van Santvoort, Martijn W J Stommel, Rogier P Voermans, Steven W M Olde Damink, Judith de Vos-Geelen, Stefan A W Bouwense
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引用次数: 0

Abstract

Objective: To evaluate treatment outcomes, overall survival (OS), and prognostic factors for OS in patients diagnosed with T1 ampullary cancer.

Background: Ampullary cancer is a rare gastrointestinal malignancy with limited data from large cohorts, especially regarding T1 disease.

Methods: Patients diagnosed with clinical (c) T1 ampullary cancer and patients with pathological (p) T1 in the case of cTx were included from the Netherlands Cancer Registry (2014-2021). Primary endpoint was OS, analyzed using the Kaplan-Meier estimator. Multivariable Cox proportional hazards regression was used to identify OS predictors.

Results: Overall, 244 patients with cT1 ampullary cancer were included, of whom 75% (n=184) underwent resection. Among these, 68% (n=125) were upstaged to a higher pathologically T classification (pT2:40%, pT3:22%, pT4:5%). Similarly, cN0 was upstaged to pN1 in 47% of patients (n=87). Next, 100 patients with pT1 and cTx ampullary cancer were included, making a total of 159 patients with pT1 tumor. 92% (146/159) underwent pancreatoduodenectomy while 8% (13/159) underwent endoscopic or local surgical resection. The 1- and 5-year OS for cT1N0 ampullary cancer were 72% and 36%, while for pT1N0 they were 94% and 75%. Independent poor prognostic factors for OS were pN1 classification (HR 2.12; 95%CI 1.15-3.94, P=0.017), pNx classification (i.e. locally resected patients) (HR 2.82; 95%CI 1.22-6.55, P=0.016), and poorly differentiated tumors (HR 4.05; 95%CI 1.33-12.40, P=0.014).

Conclusion: In patients with cT1 ampullary cancer, more than two-thirds had a pathologically higher T classification, and almost half had a pathologically higher N classification. These findings suggest that pancreatoduodenectomy is recommended for cT1 ampullary cancer.

临床诊断为 T1 级胰腺癌患者的治疗和总生存期人群队列研究
摘要评估确诊为T1型鞍状腺癌患者的治疗效果、总生存率(OS)以及OS的预后因素:背景:胰腺癌是一种罕见的胃肠道恶性肿瘤,来自大型队列的数据有限,尤其是关于T1疾病的数据:方法:从荷兰癌症登记处(2014-2021年)纳入临床(c)T1型胰腺癌患者和病理(p)T1型胰腺癌患者。主要终点为OS,采用Kaplan-Meier估计器进行分析。多变量考克斯比例危险回归用于确定OS预测因素:共纳入244名cT1级胰腺癌患者,其中75%(184人)接受了切除手术。在这些患者中,68%(n=125)的病理T分级更高(pT2:40%,pT3:22%,pT4:5%)。同样,47% 的患者(87 人)的 cN0 升为 pN1。接下来,100 名患有 pT1 和 cTx 的膀胱癌患者被纳入其中,这样共有 159 名患者患有 pT1 肿瘤。92%的患者(146/159)接受了胰十二指肠切除术,8%的患者(13/159)接受了内镜或局部手术切除。cT1N0胰壶腹癌的1年和5年生存率分别为72%和36%,而pT1N0胰壶腹癌的1年和5年生存率分别为94%和75%。OS的独立不良预后因素是pN1分级(HR 2.12;95%CI 1.15-3.94,P=0.017)、pNx分级(即局部切除患者)(HR 2.82;95%CI 1.22-6.55,P=0.016)和分化差的肿瘤(HR 4.05;95%CI 1.33-12.40,P=0.014):结论:在cT1级胰瓿癌患者中,超过三分之二的患者病理分级为较高的T级,近一半的患者病理分级为较高的N级。这些研究结果表明,建议对 cT1 ampullary 癌进行胰十二指肠切除术。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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