| Objective: Although the incidence of pancreaticoduodenal tumors is not high,no matter the anatomical location or pathological manifestations,there are relatively special tumor types,which bring great difficulties to clinical diagnosis and treatment.This study intends to investigate the role of chemotherapy in duodenal papilla carcinoma and the nutritional metabolism of pancreatic neuroendocrine tumors.Duodenal papilla carcinoma is one of periampullary carcinoma,which is rare and lack of research on chemotherapy.Pancreatic neuroendocrine tumors is also a type of tumor with a lower incidence,but the incidence rate has continued to increase in recent years,and related nutritional status studies have rarely been reported.Relying on the rich clinical resources of the affiliated hospital of the Zhejiang University,this study intends to analyze the hotspots and difficulties of the two special types of tumors.First,the postoperative adjuvant chemotherapy of patients with operable duodenal papilla carcinoma and the clinical benefit of palliative chemotherapy in patients with advanced unresectable disease was retrospectively analyzed.Second,the relationship between tumor function status of patients with endocrine tumors and preoperative serum nutritional indexes was retrospectively analyzed.Methods: This retrospective study included two independent groups.Patients with duodenal papilla cancer at the First Affiliated Hospital of Zhejiang University School of Medicine from 2010 to 2018 were retrospectively collected as the duodenal papilla carcinoma group.Survival of resected duodenal papilla carcinoma patients with or without adjuvant chemotherapy was compared,propensity score matching was further applied to balance covariates,and survival of metastatic duodenal papilla carcinoma patients treated with chemotherapy was analyzed.Patients with pancreatic neuroendocrine tumors hospitalized in the First Affiliated Hospital of Zhejiang University School of Medicine from 2009 to 2016 were retrospectively collected as the pancreatic neuroendocrine tumor group,the relationship between pancreatic neuroendocrine tumor functional status and preoperative nutritional status was analyzed.Results: In this study,162 patients with duodenal papilla carcinoma were included in the duodenal papilla cancer group,the adjuvant cohort included the chemotherapy group(32 patients)and the observation group(100 patients).The palliative cohort included 30 patients with metastatic duodenal papilla carcinoma.In the adjuvant cohort,after a 1 to 1 propensity score matching analysis,the median overall survival(OS)of the adjuvant chemotherapy group showed a trend better than that of the observation group(67.4 months vs.45.4 months,P=0.317).In the palliative cohort,the median progression-free survival(PFS)was 8.2 months,median OS was 16.5 months,the elevated serum total bilirubin level was associated with poor PFS(HR=0.351,P=0.032),old age and elevated serum total bilirubin level were associated with poor OS in patients with metastatic duodenal papilla carcinoma(HR=0.362,P=0.039;HR=0.286,P=0.023).In this study,94 patients with pancreatic neuroendocrine tumors were included in the pancreatic neuroendocrine tumor group,including 20 patients inthe functional group and 74 patients in the nonfunctional group.The serum levels of preoperative hemoglobin,albumin,total cholesterol,and low-density lipoprotein in patients with functional pancreatic neuroendocrine tumors were significantly lower than those in the non-functional group(P=0.006,0.028,0.027,0.027,respectively).Among the male patients,the functional group had significantly lower hemoglobin,albumin,total cholesterol,and low-density lipoprotein than patients with nonfunctional pancreatic neuroendocrine tumors(P = 0.031,0.014,0.024,0.024,respectively).Among patients aged 65 years or less,the serum levels of preoperative hemoglobin in patients with functional pancreatic neuroendocrine tumors were significantly lower than in the non-functional group(P = 0.014).Conclusions: Adjuvant chemotherapy may improve the survival of duodenal papilla carcinoma patients undergone radical resection.Palliative chemotherapy was effective for patients with metastatic duodenal papilla carcinoma.Elevated serum total bilirubin of patients with metastatic duodenal papilla Carcinoma was associated with a poor prognosis.Nutritional indictors of Patients with functional pancreatic neuroendocrine tumors are significantly worse than those of non-functional patients,especially in young and male patients.Clinicians should pay attention to the evaluation of their preoperative nutritional status. |
PDF Full Text Request