胰腺导管腺癌神经侵犯和肿瘤出芽的临床病理分析

Clinicopathological analysis of nerve invasion and tumor budding in pancreatic ductal adenocarcinoma

目的探讨肿瘤出芽和神经侵犯与胰腺导管腺癌(PDAC)临床病理特征及预后的关系。方法收集2010年1月至2018年1月经组织病理学诊断为PDAC且接受手术治疗的患者76例,分析临床病理特征与总生存时间(OS)的关系。结果76例患者中,70例(92.1%)有不同方式的神经侵犯。其中,6例(8.6%)为Pn-ena,42例(60.0%)为Pn-pni,22例(31.4%)为Pn-eni。64例(84.2%)患者存在肿瘤出芽。PDAC患者的中位OS为30(95%CI:26~34)个月。单因素分析显示,中位OS与淋巴结转移、组织学分级、脉管侵犯和TNM分期有关,并且肿瘤出芽5个/0.237 mm^(2)与肿瘤出芽10个/0.785 mm^(2)也与OS有关(P<0.001)。Cox多因素模型分析显示,淋巴结转移、组织学分级、脉管侵犯、TNM分期、肿瘤出芽5个/0.237 mm^(2)和肿瘤出芽10个/0.785 mm^(2)为影响PDAC患者OS的独立因素(P<0.05)。结论淋巴结转移、组织学分级、脉管侵犯、TNM分期和肿瘤出芽可以作为PDAC预后的评估指标,而神经侵犯与预后无明显关联。

Objective To investigate the relationship of tumor budding,nerve invasion with clinicopathological features and the prognosis of pancreatic ductal adenocarcinoma(PDAC).Methods A total of 76 patients with PDAC diagnosed by histopathology and underwent surgery from Jan 2010 to Jan 2018 were collected,and the relationship between clinicopathological features and overall survival(OS)was analyzed.Results Among the 76 patients,70 cases(92.1%)had different forms of nerve invasion.Among them,6 cases(8.6%)were PN-ena,42 cases(60.0%)were PN-pni and 22 cases(31.4%)were PN-eni.Tumor budding was found in 64 patients(84.2%).The median OS of PDAC patients was 30(95%CI:26-34)months.Univariate analysis showed that the median OS was related to lymph node metastasis,histological grade,vascular invasion and TNM stage(P<0.05),and meanwhile tumor budding 5/0.237 mm^(2)and tumor budding 10/0.785 mm^(2)were also related to OS(P<0.001).Cox multivariate model analysis showed that lymph node metastasis,histological grade,vascular invasion,TNM stage,tumor budding 5/0.237 mm^(2)and tumor budding 10/0.785 mm^(2)were independent factors affecting OS in PDAC patients(P<0.05).Conclusion Lymph node metastasis,histological grade,vascular invasion,TNM stage and tumor budding can be used to evaluate the prognosis of PDAC,but there is no significant correlation between nerve invasion and the prognosis.