文章：

评估形态学亚型在壶腹周围腺癌分类中的作用

Evaluating the Role of Morphological Subtypes in the Classification of Periampullary Adenocarcinomas

原文发布日期：14 November 2025

DOI: 10.3390/cancers17223652

类型: Article

开放获取: 是

英文摘要：

Background: Morphological subclassification may refine prognosis after curative pancreaticoduodenectomy (PD) for periampullary cancers.Methods: We conducted a single-center retrospective cohort including 120 consecutive PDs performed between 2005 and 2022. Tumors were classified as intestinal (INT), pancreatobiliary (PB), or pancreatic ductal adenocarcinoma (PAN). Clinicopathologic variables included T stage, margin status, lymphovascular and perineural invasion, and lymph node ratio (LNR; cutoff 0.154 determined by ROC/Youden). Overall survival (OS) was the primary endpoint and was analyzed using Kaplan–Meier with log-rank tests and multivariable Cox regression.Results: INT tumors were associated with earlier T stage, fewer adverse histologic features, and higher R0 resection rates compared with PB and PAN. In multivariable analysis, mortality risk was higher for PB (HR 4.41; 95% CI 1.25–15.53) and PAN (HR 13.96; 95% CI 3.99–48.75) relative to INT. LNR ≥ 0.154 independently predicted worse OS (HR 1.93; 95% CI 1.11–3.35). Mean OS was 108.8 months for INT, 62.0 months for PB, and 22.7 months for PAN (log-rankp< 0.001).Conclusions: Morphological subtype and LNR are independent prognostic factors after PD for periampullary malignancies. Integrating morphology and nodal burden into risk models may improve postoperative stratification and guide adjuvant therapy.

摘要翻译： 

背景：形态学亚型分类可能有助于细化壶腹周围癌根治性胰十二指肠切除术（PD）后的预后评估。 方法：本研究为单中心回顾性队列研究，纳入2005年至2022年间连续进行的120例PD手术。肿瘤被分为肠型（INT）、胰胆型（PB）和胰腺导管腺癌（PAN）。临床病理变量包括T分期、切缘状态、淋巴血管侵犯和神经侵犯，以及淋巴结比率（LNR；通过ROC/Youden法确定截断值为0.154）。主要终点为总生存期（OS），采用Kaplan–Meier法、Log-rank检验及多变量Cox回归进行分析。 结果：与PB型和PAN型相比，INT型肿瘤的T分期更早、不良组织学特征更少、R0切除率更高。多变量分析显示，相对于INT型，PB型（HR 4.41；95% CI 1.25–15.53）和PAN型（HR 13.96；95% CI 3.99–48.75）的死亡风险更高。LNR ≥ 0.154是OS较差的独立预测因素（HR 1.93；95% CI 1.11–3.35）。INT型、PB型和PAN型的平均OS分别为108.8个月、62.0个月和22.7个月（Log-rank检验p < 0.001）。 结论：形态学亚型和LNR是壶腹周围恶性肿瘤PD术后的独立预后因素。将形态学特征与淋巴结负荷纳入风险模型，可能改善术后风险分层并指导辅助治疗。

原文链接：

Evaluating the Role of Morphological Subtypes in the Classification of Periampullary Adenocarcinomas