- 期刊
Prognosis of Ampullary Carcinoma after Radical Resection and Its Carcinogenesis
根除性手術後壺腹癌之預後與致癌機轉
摘要
壺腹癌是僅次於胰臟癌的第二常見壺腹周圍癌症，接受胰十二指腸切除手術之後，文獻報導五年存活率從38.0%到67.7%，預後相關因子包括胰臟侵犯、淋巴結轉移、腫瘤分化不佳及癌症分期等，而術後輔助性化學治療無法延長存活時間。在美國疾病登記中心(SEER)的資料中，壺腹癌的手術可切除率僅40%，根除性手術後的五年存活率亦僅有36.8%，顯示壺腹癌仍是預後相當不佳的癌症之一。 回顧過去文獻，壺腹細胞可能先轉化爲腺瘤，再進一步形成癌症：其中可能牽涉到腫瘤抑制基因的剔除、致癌基因的活化、染色體的複製、細胞週期的調節、細胞骨架的變化或是細胞粘黏因子的轉化，致癌機轉非常複雜。因此，我們需要致力於壺腹癌致癌機轉之研究，藉此能發展出更好的治療方式。
關鍵字
無資料並列摘要
The carcinoma of the ampulla of Vater is the second most common periampullary cancer and also the most common neoplasm of the small intestine. In previous studies, the 5-year survival rate of patients with carcinoma of the ampulla of Vater ranged from 38.0 to 67.7% after pancreaticoduodenectomy. Lymph node involvement, poor differentiation, pancreatic invasion and tumor stage were predictors of a poor prognosis. Results vary among institutions and postoperative adjuvant chemoradiotherapy does not improve long-term survival after radical surgery. Also, in reports from the Surveillance, Epidemiology, and End Results (SEER) program in the United States, the resection rate of ampullary cancer was only 40% and 5-year survival was 36.8% in this large cohort study. From this unbiased registry data, the prognosis of ampullary carcinoma after radical resection is fair and additional treatment modalities are needed to improve survival. The adenoma to carcinoma sequence raises suspicion of carcinoma of the ampulla of Vater. In the carcinogenesis of ampullary carcinoma, possible mechanisms involve include tumor suppressors, oncogenes, DNA replication, cell cycle regulation, growth factors, the cytoskeleton and cell adhesion, among others. Nevertheless, the mechanism, which appears to be complex, remains obscure. Further efforts are needed to elucidate the mechanism and to improve the survival of patients with ampullary carcinoma.