Pancreaticoduodenectomy for duodenal papilla carcinoma: A single-centre 9-year retrospective study of 112 patients with long-term follow-up

Abstract

Aim: To retrospectively evaluate the factors that influence long-term outcomes of duodenal papilla carcinoma (DPC) after standard pancreaticoduodenectomy (SPD).

Methods: This is a single-centre, retrospective study including 112 DPC patients who had a SPD between 2006 and 2015. Associations between serum levels of CA19-9 and CEA and various clinical characteristics of 112 patients with DPC were evaluated by the χ² test and Fisher's exact test. The patients were followed-up every 3 mo in the first two years and at least every 6 mo afterwards, with a median follow-up of 60 mo (ranging from 4 mo to 168 mo). Survival analysis was conducted using the Kaplan-Meier survival and Cox proportional hazards model analysis. The difference in survival curves was evaluated with a log-rank test.

Results: In 112 patients undergoing SPD, serum levels of CA19-9 was associated with serum levels of CEA and drainage mode (the P values were 0.000 and 0.033, respectively); While serum levels of CEA was associated with serum levels of CA19-9 and differentiation of the tumour (the P values were 0.000 and 0.033, respectively). The serum levels of CA19-9 and CEA were closely correlated (χ² = 13.277, r = 0.344, P = 0.000). The overall 5-year survival was 50.00% for 112 patients undergoing SPD. The Kaplan-Meier survival analysis showed that increased serum levels of CA19-9, CEA, and total bilirubin were correlated with a poor prognosis, as well as a senior grade of infiltration depth, lymph node metastases, and TNM stage(the P values were 0.033, 0.018, 0.015, 0.000, 0.000 and 0.000, respectively). Only the senior grade of infiltration depth and TNM stage retained their significance when adjustments were made for other known prognostic factors in Cox multivariate analysis (RR = 2.211, P = 0.022 and RR = 2.109, P = 0.047).

Conclusion: For patients with DPC, the serum levels of CA19-9 and CEA were closely correlated, and play an important role in poor survival. Increased serum levels of total bilirubin and lymph node metastases were also correlated with a poor prognosis. The senior grade of infiltration depth and TNM stage can serve as independent prognosis indexes in the evaluation of patients with DPC after SPD.

Keywords: CA19-9; CEA; Duodenal papilla carcinoma; Pancreaticoduodenectomy; Survival.

Figure 1

Kaplan-Meier plots show the association of survival and significant factors. A: The overall 5-year survival was 50.00%, with a median follow-up of 60 mo (ranging from 4 mo to 168 mo); B: Increased serum levels of CA19-9 was associated with decreased survival (P = 0.033); C: Increased serum levels of CEA was associated with decreased survival (P = 0.018); D: Increased serum levels of total bilirubin was associated with decreased survival (P = 0.015); E: The senior grade of infiltration depth was associated with decreased survival (P = 0.000), with significant difference between T1 and T3, T4 (P = 0.022, 0.000), as well as the difference between T2 and T3, T4 (P = 0.036, 0.000) and the difference between T3 and T4 (P = 0.049); F: The senior grade of lymph node metastases was associated with decreased survival (P = 0.000); G: TNM stage was associated with decreased survival (P = 0.000), with significant difference between IA and IIB, III (P = 0.000, 0.000), as well as the difference between IB and IIB, III (P = 0.000, 0.000) and the difference between IIA and IIB, III (P = 0.006, 0.000).