Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2017; 23(30): 5579-5588
Published online Aug 14, 2017. doi: 10.3748/wjg.v23.i30.5579
Pancreaticoduodenectomy for duodenal papilla carcinoma: A single-centre 9-year retrospective study of 112 patients with long-term follow-up
Pei-Long Lian, Yuan Chang, Xiu-Chun Xu, Zhen Zhao, Xian-Qiang Wang, Ke-Sen Xu
Pei-Long Lian, Zhen Zhao, Ke-Sen Xu, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Yuan Chang, Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
Xiu-Chun Xu, Department of Vascular Surgery, Binhai People’s Hospital, Yancheng 224500, Jiangsu Province, China
Xian-Qiang Wang, Department of Hepatobiliary Surgery, the PLA General Hospital, Beijing 100853, China
Author contributions: Lian PL designed the research, analyzed the data, drafted and revised the paper; Wang XQ, Xu XC and Zhao Z performed the research; Chang Y searched the literature; Xu KS revised the paper, approved the final version.
Institutional review board statement: The study was reviewed and approved by the PLA General Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: We declare that there are no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ke-Sen Xu, PhD, Professor, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, 107 Wenhuaxi Road, Jinan 250012, Shandong Province, China. xukesen0519@sdu.edu.cn
Telephone: +86-531-82169230 Fax: +86-531-82169243
Received: May 3, 2017
Peer-review started: May 4, 2017
First decision: June 1, 2017
Revised: June 13, 2017
Accepted: June 18, 2017
Article in press: June 19, 2017
Published online: August 14, 2017
Abstract
AIM

To retrospectively evaluate the factors that influence long-term outcomes of duodenal papilla carcinoma (DPC) after standard pancreaticoduodenectomy (SPD).

METHODS

This is a single-centre, retrospective study including 112 DPC patients who had a SPD between 2006 and 2015. Associations between serum levels of CA19-9 and CEA and various clinical characteristics of 112 patients with DPC were evaluated by the χ2 test and Fisher’s exact test. The patients were followed-up every 3 mo in the first two years and at least every 6 mo afterwards, with a median follow-up of 60 mo (ranging from 4 mo to 168 mo). Survival analysis was conducted using the Kaplan-Meier survival and Cox proportional hazards model analysis. The difference in survival curves was evaluated with a log-rank test.

RESULTS

In 112 patients undergoing SPD, serum levels of CA19-9 was associated with serum levels of CEA and drainage mode (the P values were 0.000 and 0.033, respectively); While serum levels of CEA was associated with serum levels of CA19-9 and differentiation of the tumour (the P values were 0.000 and 0.033, respectively). The serum levels of CA19-9 and CEA were closely correlated (χ² = 13.277, r = 0.344, P = 0.000). The overall 5-year survival was 50.00% for 112 patients undergoing SPD. The Kaplan-Meier survival analysis showed that increased serum levels of CA19-9, CEA, and total bilirubin were correlated with a poor prognosis, as well as a senior grade of infiltration depth, lymph node metastases, and TNM stage(the P values were 0.033, 0.018, 0.015, 0.000, 0.000 and 0.000, respectively). Only the senior grade of infiltration depth and TNM stage retained their significance when adjustments were made for other known prognostic factors in Cox multivariate analysis (RR = 2.211, P = 0.022 and RR = 2.109, P = 0.047).

CONCLUSION

For patients with DPC, the serum levels of CA19-9 and CEA were closely correlated, and play an important role in poor survival. Increased serum levels of total bilirubin and lymph node metastases were also correlated with a poor prognosis. The senior grade of infiltration depth and TNM stage can serve as independent prognosis indexes in the evaluation of patients with DPC after SPD.

Keywords: Duodenal papilla carcinoma, CA19-9, CEA, Survival, Pancreaticoduodenectomy

Core tip: For duodenal papilla carcinoma (DPC), standard pancreaticoduodenectomy (SPD) is still the most important treatment. However, the prognosis assessment for DPC after SPD is not yet clear. So we conducted a long-term follow-up and observation with a large sample. Our study demonstrated that the serum levels of CA19-9 and CEA were closely correlated and played an important role in poor survival. Increased serum levels of total bilirubin and lymph node metastases were also correlated with a poor prognosis. The senior grade of infiltration depth and TNM stage can serve as independent prognosis indexes for patients with DPC after SPD.