Clinicopathological Features and Surgical Outcomes of Patients with Remnant Gastric Cancer after a Distal Gastrectomy

Background The incidence of gastric cancer in the remnant stomach after distal gastrectomy is increasing. The aim of this study was to evaluate the clinicopathological features and surgical outcomes of remnant gastric cancer (RGC). Methods We reviewed the medical records of 58 patients who underwent laparotomy for RGC at Seoul National University Hospital between 2000 and 2005. Results The mean interval between the first and second operations was 12.5 years, and the rate of RGC diagnosis by tests included the follow-up program was 41.4%. The 45 RGCs occurring after distal gastrectomy for initial gastric cancer had a shorter interval and were more frequently located at the non-anastomotic site than those following benign lesions (P <0.001 and P = 0.010). Of all patients, 41 (70.7%) underwent, and the overall 3-year survival rate was 62.4%. An early stage of the initial gastric cancer, no symptoms at diagnosis, curative resection, tumor size smaller than 6 cm, and an early TNM stage of the RGC were associated with longer survival; the initial gastric disease, the interval and the location of RGC were not. Conclusion The successful curative resection and an early stage of the RGC led to good outcomes. In considering the different latency periods of the two initial gastric diseases, appropriate follow-up programs should be developed.     

残胃癌外科治疗临床分析及再认识

目的分析残胃癌的外科治疗及其临床病理特征,对当前残胃癌外科治疗进行再认识。方法回顾性总结我院2004年1月至2011年3月期间经内镜和病理学检查诊断为残胃癌并行外科治疗的26例患者的临床资料,其中首次疾病为良性的残胃癌(RGCB)者14例,胃癌根治术后残胃癌(RGCC)者12例,对其临床发病、HP感染、手术方式、组织病理学特点及预后因素进行分析。结果 RGCB距第1次胃切除术后的发病时间为15～44年(中位时间为26.3年),RGCC距第1次胃切除术后的发病时间为1~10.5年(中位时间为4.0年),两者间差异有统计学意义(P<0.05)。病理检测残胃癌的HP感染率为73.1%(19/26),其中RGCB的HP感染率为71.4%(10/14),RGCC的HP感染率为75.0%(9/12),两者间差异无统计学意义(P>0.05)。26例患者均再次进行了手术治疗,其残胃癌手术根治率为46.2%(12/26),其中RGCB根治切除率为57.1%(8/14),RGCC根治切除率为33.3%(4/12),两者间差异无统计学意义(P>0.05)。在行根治性切除的12例患者中胃周淋巴结转移以小弯淋巴结转移率最高(83.3%,10/12),其次为空肠系膜淋巴结(33.3%,4/12)和脾门淋巴结(33.3%,4/12)。26例残胃癌术后病理分期:Ⅰ期3例,Ⅱ期2例,Ⅲ期14例,Ⅳ期7例。18例手术切除者术后病理报告提示有13例(72.2%)发生淋巴结转移;明确肿瘤侵犯胰腺或横结肠或脾脏者13例(50.0%);8例有腹膜转移(30.8%),其中RGCB的腹膜转移率为14.3%(2/14),明显低于RGCC的腹膜转移率(50.0%,6/12),P<0.05。全组病例累积1年总体生存率为54.5%,3年生存率为38.5%,生存时间为2～61个月(中位生存时间12个月)。生存分析结果表明,肿瘤的病理分期与是否接受根治性手术为残胃癌患者生存的影响因素(P<0.01),而患者年龄、性别、第1次疾病、病理分化程度以及HP感染均不是影响预后的相关因素(P>0.05);是否接受根治性手术为影响生存的独立预后因素(P<0.05)。结论早期诊断和根治手术是改善残胃癌患者预后的关键因素,腹腔镜探查可减少不必要的外科手术创伤。胃癌术后残胃癌与良性疾病后残胃癌在临床特点上不同,临床处理仍需区别对待。     

Preemptive Total Gastrectomy for Hereditary Gastric Cancer

Hereditary gastric cancer is a recently described clinical syndrome, associated with truncating mutation of the E-cadherin gene, named CDH1. It is characterized by autosomal dominant transmission, presentation at an early age, and with diffuse type of gastric adenocarcinoma. Clinical management of these patients is challenging and includes intense endoscopic surveillance or prophylactic gastrectomy, which is associated with short- and long-term morbidity. We report four patients submitted to a prophylactic gastrectomy performed in members of three families with hereditary gastric cancer in a tertiary referral center in Mexico City. These are the first Hispanic families with hereditary gastric cancer reported in the literature.     

胃癌合并其他器官原发癌103例分析

目的探讨胃癌合并其他器官恶性肿瘤的发生率、临床病理特征及其诊治和预后情况。方法对我院1983年1月至2010年12月期间治疗的103例胃癌合并其他器官原发癌患者的临床病理资料进行回顾性分析。结果本组103例患者占同期收治胃癌患者的2.26%(103/4 552)。确诊胃癌的年龄为(63.98±11.93)岁(30～84岁)。同时多原发癌29例;异时多原发癌74例,其中胃癌确诊前异时多原发癌46例,胃癌确诊后异时多原发癌28例。共发生胃癌以外恶性肿瘤113个,以结直肠癌最多,占27.43%(31/113),肺癌其次,占15.04%(17/113)。异时癌的发生时间距胃癌确诊前或后(87.95±92.98)个月(7～506个月),65.49%(74/113)合并的原发癌距胃癌确诊的间隔时间在5年内。全组患者总的5年累积生存率为48.43%,其中同时多原发癌患者为36.40%,胃癌确诊前发生多原发癌者为42.31%,胃癌确诊后发生多原发癌者为69.52%,胃癌确诊后发生者的预后明显好于胃癌确诊前发生者和同时发生者(P<0.023,P<0.009)。在死亡原因明确的33例患者中有20例因胃癌死亡。结论胃癌治疗时需注意同时并发其他器官原发癌的可能,对于这类患者胃癌仍然可能是影响其预后的主要原因。     

腹腔镜辅助远端胃癌根治术学习曲线研究

目的 探讨腹腔镜辅助远端胃癌根治术的学习曲线.方法 回顾分析2010年12月-2012年12月由同一术者完成的120例腹腔镜辅助远端胃癌根治手术的临床资料.按手术先后次序分为3组（A、B、C组各40例）,比较各组术中情况（手术时间、术中出血量、淋巴结清扫总数、中转开腹例数）及术后恢复情况（肛门排气时间、术后住院时间、并发症例数）.结果 与A组相比,B、C组手术时间短[A、B、C组分别为（287.8±34.9）、（200.6±21.2）、（201.8±27.7）min,F=125 012,P=0.000],术中出血量少[A、B、C组分别为（143.8±67.2）、（68.8±27.8）、（67.5±27.2）ml,F=38.018,P=0.000],淋巴结清扫数量多[A、B、C组分别为（18.3±3.4）、（25.8±4.6）、（26.3±4.9）个,F=43.047,P=0.000].B、C组之间差异均无显著性（P〉0.05）.3组肛门排气时间、术后住院时间、并发症发生率差异无显著性（P〉0.05）.结论在进行40例手术后,可完成腹腔镜辅助远端胃癌根治手术的学习曲线.     

Appropriate Gastric Resection with Lymph Node Dissection for Early Gastric Cancer

Background The extent of lymphadenectomy (limited vs. extended) and that of gastric resection (partial vs. total) remain controversial issues in the management of early gastric cancer (EGC). A multicentric study was performed to elucidate the appropriate gastric resection with lymph node dissection for early gastric cancer.Methods From 1979 to 1988, 332 patients with EGC underwent surgery in 23 French centers. Clinicopathological data, the extent of resection, and the number of lymph nodes retrieved were reviewed retrospectively and screened for prognostic effect. The mean follow-up for the 332 EGC patients was 80 months.Results Postoperative mortality was correlated to age (odds ratio [OR], 1.1) and extent of gastric resection (OR,10.3). Examination of survival data (excluding postoperative deaths) with univariate analysis and the Cox proportional hazards model showed that the independent factors for excellent prognosis included no lymphatic involvement (P = .005), 10 or more lymph nodes retrieved (P = .003), site of the tumor in the lower third of the stomach (P = .01), and mucosal lesions (P = .04). The extent of resection did not influence long-term survival.Conclusions Our results suggest that because of the associated good prognosis, the appropriate surgical treatment for EGC is partial gastrectomy with lymphadenectomy retrieving 10 or more lymph nodes.     

胃癌组织中CD133蛋白表达及其临床意义

目的研究胃腺癌组织中CD133蛋白表达及其临床意义。方法应用免疫组织化学染色方法检测99例胃癌患者手术切除的原发灶及正常胃黏膜组织中CD133蛋白的表达,分析其与临床病理特征和预后的关系。结果 29例(29.29%)患者肿瘤组织中CD133蛋白表达阳性,正常胃黏膜组织中均为阴性(P=0.000)。肿瘤直径>5 cm者CD133蛋白表达阳性率显著高于≤5 cm者(P=0.041);CD133蛋白表达与TNM分期有关(P=0.044);有淋巴结转移(P=0.017)、淋巴管浸润(P=0.000)和血管浸润(P=0.000)者,CD133蛋白表达显著增高。logistic回归分析显示:肿瘤浸润深度(P=0.011)、淋巴结转移(P=0.043)和TNM分期(P=0.049)分别是CD133蛋白表达阳性的独立危险因素。CD133蛋白表达阳性患者的术后生存时间短于表达阴性患者(P=0.046)。Cox比例风险回归模型分析显示,有淋巴结转移(P=0.042)、TNM分期(P=0.046)及CD133蛋白表达阳性(P=0.046)分别是胃癌患者预后的独立危险因素。结论胃癌组织中CD133蛋白的表达与胃癌的发展、转移及预后密切相关。     

Tumor Location of the Lower-Inner Quadrant Is Associated with an Impaired Survival for Women With Early-Stage Breast Cancer

Background There is growing evidence that tumors of the inner quadrants (especially the lower-inner quadrant) metastasize more often to the internal mammary chain (IMC). As these metastases are not investigated, patients with lower-inner quadrant tumors have an increased risk of being under-staged and under-treated and may therefore have a higher risk of death from breast cancer. Methods We identified all 1522 women operated for stage I breast cancer between 1984 and 2002 recorded at the population-based Geneva Cancer Registry. We compared breast cancer mortality risk by tumor location with multivariate Cox regression analysis that accounted for all factors linked to tumor location and survival. Results Ten-year disease-specific survival was 93% (95%CI: 91–94%). Patients with breast cancer of the lower-inner quadrant (n = 118; 7.8%) had an importantly increased risk of dying of breast cancer compared to women with breast cancer of the upper-outer quadrant (multiadjusted Hazard Ratio: 2.3, 95%CI: 1.1–4.5, P = 0.0206). The over-mortality associated with this quadrant was particularly evident for tumors >10 mm (multiadjusted HR: 3.6, 95%CI: 1.6–7.9, P = 0.0016). There was no increased breast cancer mortality risk for tumors located in other quadrants. Conclusions Tumor location in the lower-inner quadrant is an independent and important prognostic factor of stage I breast cancer. Further research is needed to evaluate if the over-mortality of patients with stage I cancer of the lower-inner quadrant is indeed a result of under-treatment due to undetected IMC metastases. If so, patients with stage I breast cancer of the lower-inner quadrant are good candidates for systematic IMC investigation. Part of this study was presented as a poster at the 28^th San Antonio Breast Cancer Symposium, December 8-11, 2005.     

腹腔镜远端胃癌D2根治手术的路径

目的:探讨腹腔镜端胃癌D2根治术的合理手术路径.方法:分析23例行腹腔镜端胃癌D2根治手术治疗的手术路径.结果:23例中22例完成腹腔镜手术,手术时间平均(232±35)min,术中出血平均(130±50)mL,平均清扫淋巴结(19±5)枚,术后胃肠功能恢复时间2~4 d.结论:腹腔镜端胃癌D2根治手术遵循从下到上、从右到左、从胃大弯到胃小弯的操作顺序是合理、可行的,淋巴清扫时,胰腺是手术操作的主要解剖定位标志,胃十二指肠动脉是最重要的血管定位标志.     

Clinical Significance of the Metastatic Lymph-Node Ratio in Early Gastric Cancer

The metastatic lymph-node ratio has important prognostic value in gastric cancer; this study focused on its significance in early gastric cancer. In total, 1,472 patients with early gastric cancer underwent curative gastrectomy between 1992 and 2001. Of these, 166 (11.3%) had histologically proven lymph-node metastasis. Prognostic factors were identified by univariate and multivariate analyses. Metastasis was evaluated using the Japanese Classification of Gastric Carcinoma (JGC) and the Union Internationale Contre le Cancer/Tumor, Node, Metastasis (UICC/TNM) Classification. The metastatic lymph-node ratio was calculated using the hazard ratio. The cut-off values for the metastatic lymph-node ratio were set at 0, <0.15, ≥0.15 to <0.30, and ≥0.30. The numbers of dissected and metastatic lymph nodes were correlated, but the number of dissected lymph nodes and the metastatic lymph-node ratio was not related. The JGC and UICC/TNM classification demonstrated stage migration and heterogeneous stratification for disease-specific survival. The metastatic lymph-node ratio showed less stage migration and homogenous stratification. The metastatic lymph-node ratio may be a superior method of classification, which provides also accurate prognostic stratification for early gastric cancer patients.     

Tumor Diameter as a Prognostic Factor in Patients with Gastric Cancer

Background  The aim of this study was to evaluate the prognostic value of tumor diameter in gastric cancer. Methods  The study group comprised a series of 1215 patients who underwent curative gastrectomy. The appropriate tumor diameter cutoff value was determined. Prognostic factors were evaluated by univariate and multivariate analyses. Results  The tumor diameter cutoff value was 100 mm. Multivariate analysis showed that tumor site, macroscopic appearance, tumor diameter, depth of invasion, and presence of lymph node metastasis independently affected prognosis in all patients. Multivariate analysis of patients with larger tumors identified depth of invasion as an independent prognostic factor. A comparison between patients with smaller and larger tumors showed marked differences in the survival of those with stage II, IIIA, and IIIB tumors. A comparison of clinicopathological factors between stage II and III patients revealed that tumors occupying the entire stomach, ill-defined, undifferentiated, and serosa-penetrating tumors, and peritoneal metastases were far more frequent in patients with larger tumors. Conclusions  Tumor diameter in gastric cancer is a reliable prognostic factor that might be a candidate for use in the staging system. To improve outcomes for patients with tumors ≥100 mm in diameter, it is necessary to establish therapeutic strategies for peritoneal metastasis, particularly in stage II and III tumors.     

Microscopic Tumor Cell Dissemination in Gastric Cancer

Purpose There is still much controversy surrounding the prognostic significance of microscopic tumor cell dissemination in gastric cancer and its correlation with histopathologic parameters. We herein investigate such dissemination, predominantly restricted to the subserosa, in patients with gastric cancer.Methods Intraoperative bone marrow aspiration was done in 26 patients undergoing resection of gastric carcinoma. Peritoneal lavage could not be done in 8 of these 26 patients. The R0-resection rate was 84% (n = 22). A cytokeratin-directed antibody and an antibody directed against carcinoembryonic antigen served for the immunocytochemical detection of tumor cells, and the alkaline phosphatase antialkaline phosphatase method was used for visualization.Results The bone marrow aspirate and peritoneal lavage fluid were immunocytochemically positive in 31% and 56% of the patients, respectively. There was a trend (P = 0.10) towards higher overall survival rates in patients with negative bone marrow samples than in those with tumor cells detected in bone marrow samples. Analyzing the results of peritoneal lavage did not reveal any significant differences. In the group of T1/2 cancers, survival was significantly worse if the bone marrow was positive for tumor cells, with 3-year survival rates of 25% vs 77%, respectively (P < 0.05).Conclusion The rates of tumor cell dissemination into the bone marrow or into the peritoneal cavity were within the scope of previous reports. Dissemination into the bone marrow resulted in significantly impaired survival in patients with T1 and T2 gastric carcinoma, and it did not correlate with known prognostic parameters.     

直肠癌术前放化疗反应的相关因素分析

目的分析与进展期直肠癌术前放化疗反应相关的临床因素。方法回顾性分析我院2005年1月至2012年12月期间107例接受术前放化疗后行根治性手术的直肠癌患者的临床资料,分析对直肠癌术前放化疗反应的影响因素。结果单因素分析结果显示,年龄、性别、肿瘤距肛缘距离、肿瘤分化程度、肿瘤浸润深度、治疗前CA19-9水平与直肠癌患者对术前放化疗反应无关（P〉0．05）,而肿瘤周径、肿瘤活动度、淋巴结转移、治疗前癌胚抗原（CEA）和血红蛋白水平与直肠癌患者对术前放化疗反应有关（P〈0．05）。进一步logistic回归分析结果显示,肿瘤活动度（P=-0．015）、治疗前CEA水平（P=O．012）和治疗前血红蛋白水平（P=0．007）是影响直肠癌患者对术前放化疗反应的独立危险因素,即直肠癌固定、治疗前CEA水平〉5．0μg／L及治疗前血红蛋白水平≤10g／L的直肠癌患者对术前放化疗反应差。结论通过对直肠癌术前放化疗影响因素的分析,可预测对放化疗的反应,指导临床进行个体化治疗及相关临床干预。     

Postoperative Evaluation of Pylorus-Preserving Procedures Compared with Conventional Distal Gastrectomy for Early Gastric Cancer

We evaluated postoperative function in 98 patients who underwent surgery for early gastric cancer between 1995 and 1998 to compare the results of pylorus-preserving procedures to those of conventional distal gastrectomy with Billroth I (B-I). The pylorus-preserving procedures included endoscopic mucosal resection (EMR), performed in 12 patients; local resection (Local), performed in 14 patients; segmental resection (Seg), performed in 8 patients; and pylorus-preserving gastrectomy (PPG), performed in 19 patients. B-I was performed in 45 patients. The nutritional status and serum albumin (Alb) levels after PPG, the hemoglobin (Hb) levels after EMR, Local, and PPG, and the present/preoperative body weight ratios after EMR, Local, Seg, and PPG were superior to those after B-I. The time before oral intake was recommenced after EMR and Local, the volume of oral intake tolerated after EMR, Local, Seg, and PPG, and the postoperative hospital stay after EMR were all superior to those after B-I. Moreover, significantly fewer patients suffered reflux symptoms after EMR, Local, and PPG, abdominal fullness after EMR, and early dumping syndrome after EMR, Local, and PPG than after B-I. There was also less evidence of gastritis after EMR, Local, and PPG, and of bile reflux after EMR, Local, and PPG, than after B-I. These findings indicate that pylorus-preserving procedures may result in a better postoperative quality of life for selected patients with early gastric cancer. Received: September 28, 2000 / Accepted: March 6, 2001     

Significance of Tumor Length as Prognostic Factor for Esophageal Cancer

Our study indicated the relationship between tumor length and clinicopathologic characteristics as well as long-term survival in esophageal cancer. A total of 116 patients who underwent curative surgery for thoracic esophageal cancer with standard lymphadenectomy in 2 fields between 2000 and 2010 were included in the study. The medical records of these patients were retrospectively reviewed. The patients with tumor length ≥3 cm had a highly significant difference in the involvement of adventitia and lymph node stations. The patients with tumor length ≤3 cm had significantly lower rates of involvement of the adventitia and lymph node stations. Tumor length could have a significant impact on both the overall survival and disease-free survival of patients with resected esophageal carcinomas and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment.     

全胃切除与近侧胃切除治疗胃底贲门部癌术后生存状态对比分析

目的研究全胃切除术治疗胃底贲门部癌在术后生存状况方面的意义。方法回顾性分析1997年5月至2012年10月期间兰州大学附属白银医院普通外科手术治疗的118例胃底贲门部癌患者的临床资料,其中行全胃切除术（全胃切除组）65例,行近侧胃切除术（近侧胃切除组）53例;对比分析2组患者的术后并发症、生存率、生活质量、营养指标等相关资料。结果①术后并发症发生率全胃切除组为7．7％（5／65）,近侧胃切除组为13．2％（7／53）,2组术后主要并发症发生率比较差异无统计学意义积X2=0．972,P=O．248）。②术后1、3、5年生存率全胃切除组分别为63．1％、46．2％及30．8％,近侧胃切除组分别为66．O％、36．9％及18．5％,2组1年生存率比较差异无统计学意义贸=0．193,P=O．402）,全胃切除组的3、5年生存率明显高于近侧胃切除组呼X2=4．508,P=O．022;X2=30．271,P=-O．000）。③Spi~er生活质量评分在术后不同时相全胃切除组和近侧胃切除组间比较差异均无统计学意义（P〉0．05）。术后不同时相Chew-wun Wu特殊症状量表评分：术后3个月时,全胃切除组烧心感的评分明显高于近侧胃切除组（P〈0．05）;术后6个月时,全胃切除组的烧心感和吞咽闲难的评分均明显高于近侧胃切除组∽〈0．05）;术后12个月时,食欲、进食量、烧心感和吞咽困难的评分均明显高于近侧胃切除组（P〈0．05）;其余指标2组间比较差异均无统计学意义（P〉0．05）。④全胃切除组和近侧胃切除组术后营养指标比较差异均无统计学意义（P〉0．05）。结论从本组资料看,全胃切除术治疗胃底贲门部癌,不增加并发症发生率,并能提高患者长期生存率,术后患者总体生存质量优于近侧胃切除术。     

CD44与CD133蛋白在胃癌组织中的表达及其临床意义

目的研究肿瘤干细胞标志物CD44及CD133蛋白的表达与胃癌临床病理特征和预后的关系。方法应用免疫组化方法检测100例胃癌组织中CD44和CD133蛋白的表达情况,并对CD133及CD44表达与胃癌患者的临床病理资料和生存率进行统计分析。结果CD133和CD44蛋白均主要表达在细胞膜,少量在细胞浆中表达。两者的表达均与患者的年龄和性别无关（P〉0．05）,但与肿瘤的大小、组织学分化程度、血管浸润、淋巴管浸润、淋巴结转移以及pTMN分期有关,肿瘤直径越大（CD44P=0．015;CD133P=0．002）、组织学分化程度越差（CD44P=0．008;CD133P=0．019）、有血管浸润（CD44P=0．043;CD133P=0．023）、有淋巴管浸润（CD44P=0．020;CD133P=0．044）、有淋巴结转移（CD44P=0．002：CD133P=0．004）、肿瘤浸润越深（CD44P=0．006;CD133P=0．021）以及pTNM分期越高（CD44P=0．034;CD133P=0．001）,其CD44和CD133蛋白的表达阳性率越高。CD44＋CD133＋双阳性表达与患者的年龄、性别、肿瘤的组织学分化程度以及血管浸润均无关（P〉0．05）,但与肿瘤大小、淋巴管浸润、肿瘤T分期、N分期以及pTNM分期有关,其中,肿瘤直径越大（P=0．010）、有淋巴管浸润（P=0．003）、有淋巴结转移（P=0．045）、肿瘤浸润越深（P=0．041）以及pTNM分期越高（P=0．049）,其CD44＋CD133＋双阳性表达率越高。单因素生存分析结果显示,淋巴结转移（P〈0．001）、TNM分期（P=0．013）、CD44蛋白阳性表达（P=0．005）、CD133蛋白阳性表达（P=0．002）以及CD44＋CD133＋双阳性表达（P〈0．001）和患者的3年生存率均有关。Spearman等级相关分析结果表明,CD44蛋白的表达与CD133蛋白的表达呈正相关（r=0．207,P=0．039）。logistic回归分析提示CD44＋CD133＋蛋白双阳性表达是淋巴结转移（P=0．038）的独立危险因素。Cox风险回归多因素生存分析显示,淋巴结转移（P=0．006）以及CD44和CD133蛋白的共表达（P=0．003）是影响胃癌患者术后生存的独立预后因素。结论CD44和CD133可作为胃癌干细胞的肿瘤标志物;CD44与CD133蛋白的共表达是影响胃癌患者预后的独立危险因素,与患者预后密切相关,其表达水平越高,预后越差。     

影响胰头癌根治术预后的多因素分析——肿瘤出芽是预后的独立影响因素

目的探讨肿瘤出芽在胰头癌根治术后评价预后中的作用。方法肿瘤出芽定义为肿瘤浸润前沿的单个或一簇个数<5的肿瘤细胞,200倍显微镜视野下(0.785 mm2)计数肿瘤出芽的个数。回顾性分析2005～2010年67例因胰头癌行根治性切除术患者的临床病理资料及随访资料,对影响预后的临床病理因素进行多因素分析。结果 (1)67例胰头癌患者中肿瘤出芽个数0～59个/0.785 mm2,中位数19个/0.785 mm2。采用接受者运行曲线(ROC)定义肿瘤出芽个数≥17为肿瘤出芽高密度组,<17为肿瘤出芽低密度组。本研究肿瘤出芽高密度组39例(58.2%),低密度组28例(41.8%)。肿瘤出芽高密度组年龄小(P=0.007),T分期高(P=0.007),N分期高(P=0.002),AJCC分期高(P=0.004),神经浸润发生率高(P=0.004),组织学分级高(P=0.001),术后早期复发多(P=0.001),2年生存率低(P=0.000)。(2)存活26例,死亡41例。中位生存时间12个月(3～59个月)。单因素分析结果显示,T分期(P=0.009)、N分期(P=0.003)、AJCC分期(P=0.006)、组织学分级(P=0.034)和肿瘤出芽(P=0.000)与胰头癌患者的生存时间有关,多因素Cox回归分析结果显示,肿瘤出芽高密度是胰头癌患者预后的独立影响因素(HR=3.093,95%CI 1.314～7.283,P=0.010)。结论肿瘤出芽高密度是胰头癌根治性切除术后预后不良的重要因素。