| Objective1. To investigate the rationality, advantages and indication of local resection for duodenal papilla neoplasm.2. To decide the clinicopathologic parameters that may influence the long time curative effect in patients with resected duodenal papilla neoplasm.3. To evaluate the feasibility of use immunochmistry (IHC) with expression of Ezrin and E-cadherin to determine the biological behavior of duodenal papilla neoplasm. Combine with clinicopathological data, to explore correlation and prognostic significance of Ezrin, E-cadherin protein in duodenal papilla neoplasm.Methods1. Summary the clinicopathologic records and retrospectively review the information for patients with duodenal papilla neoplasm resected between March2003and July2011in First Affiliated Hospital of Zhengzhou University, Statistics was performed using SPSS17.0, differences and association were analyzed by chi-square and spearman respectively. The Kaplan-Meier method and the Log-rank test were employed to examine the survival data, at P<0.05. Multivariate analysis was performed using the Cox proportional hazards model with the backward stepwise selection procedure. The probability for entering the model was P<0.05. Compare the local resection with pancreaticoduodenectomy in operative time, blood loss in operation, postoperative stay, incidence of complication and survival time in the aim to find advantages and indication of local resection.2. The relevance between clinicopathological parameters (diameter of tumor, differention of tumor, deepness of tumor invaded, lymph nodes metastasis and so on) and survival time after resection was further examined by the Kaplan-Meier method, log-rank test, and Cox proportional hazards regression to assess, in the aim to find factors that influence long-term survive in patients with resected duodenal papilla neoplasm.3. Immunohistochemistry (S-P method) was done for28cases of adenoma and46cases of carcinoma tissues, analyze the relationship between the clinical fctors and protein expression in the duodenal papilla cancer and clinical prognosis. Same method was done for38cases of head of pancreatic carcinoma tissues to assess the biological behavior of duodenal papilla neoplasm in adhesion, invasion and metastasis.Results1. Local excision group were significantly lower than pancreaticoduodenectomy group in operative time, blood loss in operation, postoperative stay, incidence of complication(P<0.05), in benign tumors without lymph node or surrounding organs metastase, compare local resection with pancreatoduodenectomy, the survival difference in two procedures was no significant difference(P>0.05).2. Univariate analysis showed that the differentiation status, clinical stages, lymph node metastasis of duodenal papilla neoplasm were highly related to post-srugery survival rates, but age, sex, tumor size and depth of tumor invasion were not related to post-srugery survival rates. Multivariate analysis showed that the differentiation stastus, lymph node metastasis were independent prognostic factors and the most important risk factors that influence the post-operative long-term survive. 3. Ezrin was mainly expressed in the cytoplasm or membrane of duodenal papilla cancer cells, the expression of different colors were stained with the yellow, brownish yellow to brown color range. The rates of Ezrin protein expression in duodenal papilla adenoma and carcinoma tissues were46.23%(13/28) and73.91%(34/46), respectively, difference was significantly(x2=5.674, P<0.05). In the poorly differentiated group, lymph node metastasis and â…¢,â…£stages of duodenal cancer tissue, the expression rate of Ezrin was significantly higher than that of high-differentiated group, without lymph node metastasis and â… ,â…¡ stages of the cancer tissues (P<0.05).4. E-cadherin was mainly expressed in the cytoplasm or membrane of duodenal papilla tissue cells. The rates of E-cadherin protein expression in duodenal papilla adenoma and carcinoma tissues were85.71%(24/28) and21.74%(10/46), respectively, difference was significantly(x2=28.684, P<0.05). In the poorly differentiated group, lymph node metastasis and â…¢,â…£ stages of duodenal cancer tissue, the expression rate of Ezrin was significantly lower than that of high-differentiated group, without lymph node metastasis and â… ,â…¡ stages of the cancer tissues (P<0.05).5. Expression of Ezrin was negatively correlated with E-cadherin (r=-0.407, P<0.05), and highly related to clinical prognosis. Survival rate of low expression of Ezrin, high expression of E-cadherin was significantly higher than Ezrin high expression, E-cadherin low expression groups.6. The rates of Ezrin and E-cadherin protein expression in head of pancreatic tissues were92.11%(35/38) and5.26%(2/38), respectively, being significantly different from those in duodenal papilla carcinoma tissues (P<0.05).Conclusion1. Compared with pancreaticoduodenectomy, local excision had advantages in lesser trauma, lower complication rate, but survival difference was not significantly.2. The differentiation status of duodenal papilia carcinoma, lymph node metastasis, expression of Ezrin, E-cadherin were independent prognostic factors and the most important risk factors that influence the post-operative long-term survive, but there is no evidence that they can be used as the basis of the choice of surgery.3. The rate of Ezrin protein expression in duodenal papilla carcinoma tissues was significantly higher than the rate that in adenoma tissues (P<0.05), highly related to the differentiation status of tumor, clinical stages and lymph nodes metastasis, but not related to age, sex, tumor size and depth of tumor invasion.4. The rate of E-cadherin protein expression in duodenal papilla carcinoma tissues was significantly lower than those in adenoma tissues (P<0.05), highly related to the differentiation status of tumor, clinical stages and lymph nodes metastasis, but not related to age, sex, tumor size and depth of tumor invasion.5. Expression of Ezrin was negatively correlated with E-cadherin in duodenal papilla carcinoma tissues, indicating that they may have a negative synergy in invasion and metastasis. Ezrin higher expression, E-cadherin lower expression group had higher risk of death than those of Ezrin lower expression, E-cadherin higher expression group, but the interactive mechanisms need further study.6. Compared with the head of pancreatic carcinoma, duodenal papilla carcinoma have better biological behaviors in invasion and metastasis, which may be used as the theoretical basis of molecular biology for local excision of duodenal papilla carcinoma. |
PDF Full Text Request