早发性胰腺癌的临床病理特征及预后的单中心回顾性研究

Clinicopathologic characteristics and prognosis of early-onset pancreatic cancer: a single-center retrospective analysis

摘要:

背景与目的 胰腺癌是一种恶性程度极高、预后极差的消化系统肿瘤。近年来其发病呈年轻化趋势，早发性胰腺癌（EOPC，诊断年龄≤50岁）比例逐年上升，可能具有独特的生物学行为和预后特征。国内针对EOPC的系统研究较少，因此本研究探讨EOPC患者的临床病理特征及其预后。方法 回顾性分析2017年1月─2023年12月中南大学湘雅医院收治的113例EOPC患者的临床资料，包括一般资料、临床病理特征及预后信息。采用Kaplan-Meier法绘制生存曲线，并比较手术组与非手术组的生存差异。结果 113例EOPC患者中位年龄为46（42~49）岁，男性占65.49%。A型及O型血型占比最高（40.71%和34.51%）。主要临床症状为腹痛（69.91%）、体质量下降（62.83%）、黄疸（43.36%）和腹胀（36.28%）。影像学显示胆管扩张32.74%，主胰管扩张39.82%，血管侵犯59.29%，远处转移52.21%。病理结果显示腺癌及导管腺癌占93.81%，以中、低分化为主（共76.10%），胰头部发病最常见（65.42%）。TNM分期显示，淋巴结转移率高达77.88%，临床Ⅳ期占52.21%。实验室检查中CA19-9显著升高。Kaplan-Meier分析显示，全队列中位总生存期为18.6个月；手术组明显优于非手术组（29.4个月vs. 13.8个月，P=0.001 5）。结论 EOPC患者多为男性，病变好发于胰头部，临床表现隐匿，确诊时多已进展期或伴远处转移，具有分化差、侵袭性强的特点。手术切除显著改善患者生存，是延长预后的关键。年轻人群出现不明原因腹痛、体质量下降或黄疸等症状时，应提高警惕，加强影像学筛查，争取早期诊断与手术机会。未来需开展多中心、大样本前瞻性研究以进一步验证本研究结果。

Abstract:

Background and Aims Pancreatic cancer is one of the most aggressive malignancies of the digestive system and is associated with an inferior prognosis. In recent years, its incidence has shown a trend toward younger onset. Early-onset pancreatic cancer (EOPC), defined as pancreatic cancer diagnosed at ≤50 years of age, has been increasing annually and may possess distinct biological and prognostic characteristics. Given the limited data from China, this study aimed to investigate the clinicopathological features and prognostic outcomes of EOPC patients.Methods Clinical data of 113 patients with EOPC admitted to Xiangya Hospital, Central South University, from January 2017 to December 2023 were retrospectively analyzed. Variables included demographic characteristics, clinicopathological features, and survival information. Kaplan-Meier survival curves were plotted, and differences in survival between the surgical and non-surgical groups were compared.Results The median age at diagnosis was 46 (42-49) years, and males accounted for 65.49% of cases. Blood type A (40.71%) and type O (34.51%) were most common. The main presenting symptoms were abdominal pain (69.91%), weight loss (62.83%), jaundice (43.36%), and abdominal distension (36.28%). Imaging findings showed bile duct dilation in 32.74%, pancreatic duct dilation in 39.82%, vascular invasion in 59.29%, and distant metastasis in 52.21% of patients. Histopathology revealed that adenocarcinoma and ductal adenocarcinoma accounted for 93.81% of all cases, with predominantly moderate or poor differentiation (76.10%). Tumors were the most frequently located in the pancreatic head (65.42%). TNM staging showed lymph node metastasis in 77.88% and stage Ⅳ disease in 52.21%. Laboratory tests demonstrated markedly elevated CA19-9 levels. Kaplan-Meier analysis indicated a median overall survival of 18.6 months for the entire cohort, with significantly longer survival in the surgical group compared with the non-surgical group (29.4 months vs. 13.8 months, P=0.001 5).Conclusion EOPC predominantly affects males and tends to arise in the pancreatic head. It is often diagnosed at an advanced stage or with distant metastasis and is characterized by poor differentiation and strong invasiveness. Surgical resection markedly improves survival and remains the key to prolonged prognosis. Young individuals presenting with unexplained abdominal pain, weight loss, or jaundice should be carefully evaluated through imaging to enable early diagnosis and timely surgical intervention. Future multicenter, large-sample prospective studies are warranted to validate these findings further.