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。

Multivariate Analysis of Predictors of Pancreatic Head Cancer after Total Resection:Tumor Budding is an Independent Factor

Objective To investigate the role of tumor budding in predicting the prognosis of pancreatic cancer after total resection.Methods Tumor budding was defined as a single or a cluster of tumor cells(<5 tumor cells) infiltrating the stroma at the invasive front,the number of tumor budding was counted in a ×200 microscopic field(0.785 mm2).The clinical,pathological and follow-up data of 67 patients with pancreatic head cancer,who received total resection in our hospital from 2005 to 2010,were enrolled into this study for a multivariate analysis of the predictors of the tumor.Results The number of tumor budding was 0-59/0.785 mm2,with a median of 19/0.785 mm2 in the 67 cases.Based on receiver operation curve(ROC),the number of tumor budding ≥ 17 was defined as high-density group(39 cases,58.2%),and <17 was low-density group(28 cases,41.8%).High-density group showed significantly younger age(P=0.007),higher T classification(P=0.007),higher N stage(P=0.002),higher AJCC staging(P=0.004),higher incidence of perineural invasion(P=0.004),higher G grade(P=0.001),more early recurrence(P=0.001),and lower 2-year survival rate(P=0.000) than the low-density group.Totally 26 patients survived,the other 41 died.The median survival time was 12 months(3 to 59 months).Univariate analysis showed that T classification(P=0.009),N stage(P=0.003),AJCC staging(P=0.006),G grade(P=0.034),and tumor budding(P=0.000) were related to the survival time of patients with pancreatic head cancer.And Cox regression confirmed that tumor budding was the only independent prognostic factor of pancreatic head cancer(HR=3.093,95% CI 1.314-7.283,P=0.010).Conclusions High-density tumor budding is an important negative prognostic factor for pancreatic head cancer.