Analysis Of Risk Factors Affecting The Prognosis Of 185 Cases Of Periampullary Carcinoma After Pancreaticoduodenectomy

BackgroundPeriampullary carcinoma refers to cancers that originate within 2cm of the ampulla of Vater,accounting for 5%of all gastrointestinal malignancies.The reported incidence is less than 1 case per 100,000 people,and it is increasing year by year.Clinically,it includes ampullary carcinoma,duodenal papillary carcinoma,pancreatic head carcinoma and common bile duct carcinoma.Pancreaticoduodenectomy is the main method for the treatment of PACs,with a 5-year survival rate of 5%to 40%.The histopathological types are mostly duodenal type and pancreaticobiliary type.Studies have shown that different pathological types have a certain impact on the prognosis of patients.Patients with PACs with the same histopathological type but different anatomical locations have similar survival rates.Therefore,it may be more meaningful to analyze PACs according to tumor histopathological classification.The anatomical structure of the ampulla is complicated,and multiple duct systems converge here.There are not many clinical research cases on periampullary carcinoma.Therefore,it is of great significance to understand the biological behavior of periampullary carcinoma and to collect more cases to analyze its prognostic factors.ObjectiveTo explore the clinical characteristics of patients with PACs undergoing PD and analyze the risk factors that affect their prognosis.MethodCollected the medical records of 185 patients with PACs who underwent PD from January 2015 to January 2020 in the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Zhengzhou University.1.The postoperative pathological sections of 185 patients were reviewed by two senior physicians in the Department of Pathology of our hospital,and were grouped according to common histopathological classification according to the WHO classification of digestive system tumors(2019):130 cases of duodenal adenocarcinoma and 55 cases of pancreaticobiliary duct adenocarcinoma.Compare the differences between the two groups of patients in clinical features,pathological features and other factors.2.Carry out a single factor analysis of the risk factors that may affect the prognosis of PD for PACs,and carry out a multivariate analysis of statistically significant variables to screen out independent risk factors that affect the prognosis.And draw the survival curve chart of related risk factors that affect the prognosis.Results1:There were a total of 185 patients in the whole group,the male to female ratio was 1.4:1,the average age was 562±10 years,and the 1,3,and 5-year cumulative survival rates were 72.9%,39.1%,and 32.5%,respectively.130 in the duodenal group,and 55 in the pancreaticobiliary duct group.There was no significant difference between the two groups of patients in age,tumor diameter,laboratory examination,first symptoms,TNM staging,tumor differentiation,vascular tumor thrombus,postoperative complications,postoperative hospital stay,and radiotherapy and chemotherapy(P all>0.05)There were 69(53.1%)and 61(46.9%)males and females of duodenal type,40(72.7%)and 15(27.3%)males and females of pancreaticobiliary type.There was a statistically significant difference in gender between the two groups(P=0.013).More male patients with pancreaticobiliary duct type.2:In the duodenal type group,the imaging report showed that the duodenal papilla(13.8%)occupied more than the pancreaticobiliary duct type(3.6%)(P=0.041).The image report of pancreaticobiliary duct type group showed more pancreatic head(30.9%)than duodenal type group(9.2%)(P<0.001).There were 102 cases(78.5%)and 33 cases(60%)in the duodenal type and pancreaticobiliary duct type in T0-T2 stages,28 cases(21.5%)and 22 cases(40%)in T3-T4 stages respectively,and the difference was statistically significant(P=0.01).There were 45 cases(34.6%)of duodenal type nerve invasion,41 cases(74.5%)of pancreaticobiliary duct type nerve invasion(P<0.001).The 1,2,3-year survival rates of duodenal type were 76.5%,60.9%,50.2%,respectively.The pancreaticobiliary duct types were 62.3%,30.4%,20.3%,respectively.There was a different in the 1,2,3-year survival rates between the two groups(P=0.029,P<0.001,P<0.001).3:Univariate analysis showed:ALT(P<0.001),AST(P=0.001),CA19-9(P=0.001),presence of vascular tumor thrombus(P=0.004),TNM staging(P=0.003),T stage(P=0.045),N stage(P=0.002),histopathological classification(P=0.004),and the presence or absence of postoperative and chemotherapy(P=0.011)are the related risk factors affecting the prognosis of PACs after PD4:COX multivariate analysis showed that histopathological classification(P<0.001)and the presence or absence of postoperative chemotherapy(P=0.004)were independent risk factors affecting the prognosis of PACs after PD.ConclusionCompared with duodenal type PACs,pancreaticobiliary duct type is more prone to local tumor invasion and nerve invasion,and the long-term survival rate is lower.ALT≥40 U/L,AST≥40 U/L,CA19-9≥37 U/ml,presence of vascular tumor thrombus,TNM stage Ⅲ-Ⅳ,T3-T4 stage,N2 stage,histopathological classification of pancreaticobiliary adenocarcinoma and no postoperative chemotherapy are related risk factors that affect the poor prognosis after PD for PACs.Histopathological classification of pancreaticobiliary adenocarcinoma and no postoperative chemotherapy are independent risk factors that affect the poor prognosis of PACs after PD.