十二指肠乳头腺癌危险因素分析

Risk factors for adenocarcinoma of duodenal papilla

摘要:

目的 对比十二指肠乳头腺瘤与腺癌的患者临床与内镜特征差别，探索十二指肠乳头腺癌的危险因素，提高乳头肿瘤性质判断的准确性。方法 回顾性纳入2018年1月1日至2023年6月1日在南京大学医学院附属鼓楼医院明确诊断为十二指肠乳头腺癌和腺瘤的患者。收集并对比腺癌和腺瘤患者的人口统计学、临床表现、实验室检查、影像学、内镜和病理特征，采用logistic回归分析十二指肠乳头腺癌的危险因素。结果 本研究共纳入119例腺癌和171例腺瘤患者，腺癌和腺瘤患者在年龄、体重指数、临床症状、恶性肿瘤家族史、胆管扩张、胰管扩张、病变大小、腺瘤部位分型、EUS分期、EUS胆胰管受累等方面差异均有统计学意义（P<0.05）。单因素logistic回归分析表明，非壶腹周围型病变、超声内镜分期非局限于十二指肠主乳头、超声内镜示胆胰管受累、年龄≥60岁、病变大小≥1.5 cm、临床症状、恶性肿瘤家族史、胆管扩张、胰管扩张为十二指肠乳头腺癌的危险因素（P<0.05）。进一步多因素logistic回归分析评估发现，非壶腹周围型病变（OR=7.00，95%CI：1.44~34.15，P=0.016）、超声内镜分期非局限于十二指肠主乳头（OR=13.77，95%CI：4.69~40.45，P<0.001）、年龄≥60岁（OR=2.52，95%CI：1.23~5.18，P=0.011）、胆管扩张（OR=2.58，95%CI：1.12~5.94，P=0.026）、病变大小≥1.5 cm（OR=2.76，95%CI：1.36~5.59， P=0.005）是十二指肠乳头腺癌的独立危险因素。结论 非壶腹周围型病变、超声内镜分期非局限于十二指肠主乳头、年龄≥60岁、胆管扩张、病变大小≥1.5 cm是十二指肠乳头腺癌的独立危险因素。

Abstract:

Objective To explore the risk factors for duodenal papillary adenocarcinoma by comparing the differences in clinical and endoscopic features between patients with duodenal papillary adenomas and adenocarcinomas. Methods This study retrospectively included patients diagnosed as having duodenal papillary adenocarcinoma and adenoma from January 1st 2018 to June 1st 2023 at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. Demographic, clinical manifestations, laboratory tests, imaging, endoscopic and pathological characteristics of patients with adenomas and adenocarcinomas were collected and compared. Multivariable logistic regression analysis was employed to identify high‑risk factors for duodenal papillary adenocarcinoma. Results A total of 119 cases of adenocarcinoma and 171 cases of adenoma were included. There were statistically significant differences between the two groups in terms of patient age, body mass index (BMI), clinical symptoms, family history of malignant tumors, bile duct dilation, pancreatic duct dilation, lesion size, adenoma site classification, stage assessed by EUS, and involvement of the bile and pancreatic ducts (P<0.05). Univariate logistic regression analysis revealed that non‑ampullary lesions, involvement not limited to the major duodenal papilla assessed by EUS, involvement of the bile and pancreatic ducts assessed by EUS, age ≥60 years, lesion size ≥1.5 cm, clinical symptoms, family history of malignant tumors, bile duct dilation, and pancreatic duct dilation were risk factors for duodenal papillary adenocarcinoma. Multivariate logistic regression analysis showed that non‑ampullary lesions (OR=7.00, 95%CI:1.44-34.15,P=0.016), involvement not limited to the major duodenal papilla assessed by EUS (OR=13.77, 95%CI: 4.69-40.45, P<0.001), age ≥60 years (OR=2.52, 95%CI: 1.23-5.18, P=0.011), bile duct dilation (OR=2.58, 95%CI: 1.12-5.94, P=0.026), and lesion size ≥1.5 cm (OR=2.76, 95%CI:1.36-5.59, P=0.005) were independent risk factors for duodenal papillary adenocarcinoma. Conclusion This study shows the independent risk factors for duodenal papillary adenocarcinoma, which include non‑ampullary lesions, involvement not limited to the major duodenal papilla assessed by EUS, age ≥60 years, bile duct dilation, and lesion size ≥1.5 cm.