Background: The aim of this study is to compare the prognostic impact of 2 precursor lesions of ampullary adenocarcinoma, intra-ampullary papillary-tubular neoplasm (IAPN) and flat dysplasia (FD). Methods: From December 1994 to December 2012, a total of 359 patients underwent curative surgery for ampullary adenocarcinoma. Results: The precursor lesions were IAPNs in 134 (37.3%) patients and FD in the other 225 (62.7%) patients. The FD group had more aggressive tumor biology with advanced T stage (p = 0.002), nodal involvement (p < 0.001), poor differentiation (p < 0.001), perineural and lymphovascular invasion (p < 0.001), and pancreatobiliary or mixed subtype (p < 0.001). Five-year overall survival rates were 71.1% in the IAPN group and 51.4% in the FD group (p = 0.002), respectively. Five-year disease-free survival rates were 69.7% in the IAPN group and 49.6% in the FD group (p < 0.001), respectively. The recurrence rate was also higher in the FD group (49.8 vs. 30.6%; p < 0.001). On multivariate analysis, higher levels of tumor markers including CEA and CA19-9, lymph node metastasis, poorly differentiated histology, and perineural invasion were negative predictive factors for survival. Higher levels of CEA and CA19-9, lymphovascular invasion, and FD were independent prognostic factors for recurrence. Conclusion: FD was significantly associated with worse prognosis and a greater tendency toward advanced disease. Further studies are needed to clarify the impacts of these precursor lesions.

中文翻译：

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壶腹内乳头管状肿瘤与扁平异型增生作为壶腹腺癌前驱病变的预后影响

背景：本研究的目的是比较壶腹腺癌、壶腹内乳头管状肿瘤 (IAPN) 和扁平发育不良 (FD) 的 2 种前驱病变对预后的影响。方法：1994年12月至2012年12月，共收治壶腹腺癌359例。结果：134 例（37.3%）患者的前驱病变为 IAPNs，其他 225 例（62.7%）患者为 FD。FD 组具有更高的侵袭性肿瘤生物学，具有晚期 T 分期（p = 0.002）、淋巴结受累（p < 0.001）、分化差（p < 0.001）、神经周围和淋巴血管侵犯（p < 0.001）以及胰胆管或混合亚型（ p < 0.001)。IAPN 组和 FD 组的五年总生存率分别为 71.1% 和 51.4% (p = 0.002)。五年无病生存率为 69。IAPN 组为 7%，FD 组为 49.6% (p < 0.001)。FD 组的复发率也更高（49.8% vs. 30.6%；p < 0.001）。在多变量分析中，包括 CEA 和 CA19-9 在内的较高水平的肿瘤标志物、淋巴结转移、低分化组织学和神经周围浸润是生存的阴性预测因素。较高水平的 CEA 和 CA19-9、淋巴血管浸润和 FD 是复发的独立预后因素。结论：FD 与较差的预后和更大的晚期疾病趋势显着相关。需要进一步的研究来阐明这些先兆病变的影响。包括 CEA 和 CA19-9 在内的较高水平的肿瘤标志物、淋巴结转移、低分化组织学和神经周围浸润是生存的阴性预测因素。较高水平的 CEA 和 CA19-9、淋巴血管浸润和 FD 是复发的独立预后因素。结论：FD 与较差的预后和更大的晚期疾病趋势显着相关。需要进一步的研究来阐明这些先兆病变的影响。包括 CEA 和 CA19-9 在内的更高水平的肿瘤标志物、淋巴结转移、低分化组织学和神经周围浸润是生存的阴性预测因素。较高水平的 CEA 和 CA19-9、淋巴血管浸润和 FD 是复发的独立预后因素。结论：FD 与较差的预后和更大的晚期疾病趋势显着相关。需要进一步的研究来阐明这些先兆病变的影响。FD 与较差的预后和更大的晚期疾病趋势显着相关。需要进一步的研究来阐明这些先兆病变的影响。FD 与较差的预后和更大的晚期疾病趋势显着相关。需要进一步的研究来阐明这些先兆病变的影响。