Maire F, Hammel P, Terris B, Paye F, Scoazec J-Y, Cellier C, Barthet M, O'Toole D, Rufat P, Partensky C, Cuillerier E, Lévy P, Belghiti J, Ruszniewski P
Fédération Médico-Chirugicale d'Hépato-Gastroentérologie, Hôpital Beaujon, Clichy, France.
Gut. 2002 Nov;51(5):717-22. doi: 10.1136/gut.51.5.717.
Although the prognosis in malignant resectable intraductal papillary mucinous tumours of the pancreas (IPMT) is often considered more favourable than for ordinary pancreatic ductal adenocarcinoma, the long term outcome remains ill defined.
To assess prognostic factors in patients with malignant IPMT after surgical resection, and to compare long term survival rates with those of patients surgically treated for ductal adenocarcinoma.
Seventy three patients underwent surgery for malignant IPMT in four French centres. Clinical, biochemical, and pathological features and follow up after resection were recorded. Patients with invasive malignant IPMT were matched with patients with pancreatic ductal adenocarcinoma, according to age and TNM stages; survival rates after resection were compared.
Surgical treatment for IPMT were pancreaticoduodenectomy (n=46), distal (n=14), total (n=11), or segmentary (n=2) pancreatectomy. The operative mortality rate was 4%. IPMT corresponded to in situ (n=22) or invasive carcinoma (n=51). In the latter group, 17 had lymph node metastases. Overall median survival was 47 months. Five year survival rates in patients with in situ and invasive carcinoma were 88% and 36%, respectively. On univariate analysis, abdominal pain, preoperative high serum carbohydrate antigen 19.9 concentrations, caudal localisation, invasive carcinoma, lymph node metastases, peripancreatic extension, and malignant relapse were associated with a fatal outcome. Using multivariate analysis, lymph node metastases were the only prognostic factor (OR 7.5; 95% CI: 3.4 to 16.4). Overall five year survival rate was higher in patients with malignant invasive IPMT compared with those with pancreatic ductal carcinoma (36 v 21%, p=0.03), but was similar in the subset of stage II/III tumours.
The prognosis of patients with resected in situ/invasive stage I malignant IPMT is excellent. In contrast, prognosis of locally advanced forms is as poor as in patients with pancreatic ductal adenocarcinoma.
尽管胰腺导管内乳头状黏液性肿瘤（IPMT）可切除恶性肿瘤的预后通常被认为比普通胰腺导管腺癌更有利，但长期预后仍不明确。
评估手术切除后恶性IPMT患者的预后因素，并将长期生存率与接受导管腺癌手术治疗的患者进行比较。
在法国的四个中心，73例患者接受了恶性IPMT手术。记录临床、生化和病理特征以及切除后的随访情况。根据年龄和TNM分期，将侵袭性恶性IPMT患者与胰腺导管腺癌患者进行匹配；比较切除后的生存率。
IPMT的手术治疗方式为胰十二指肠切除术（n = 46）、远端胰腺切除术（n = 14）、全胰腺切除术（n = 11）或节段性胰腺切除术（n = 2）。手术死亡率为4%。IPMT对应于原位癌（n = 22）或浸润性癌（n = 51）。在后一组中，17例有淋巴结转移。总体中位生存期为47个月。原位癌和浸润性癌患者的五年生存率分别为88%和36%。单因素分析显示，腹痛、术前血清糖类抗原19.9浓度升高、尾部定位、浸润性癌、淋巴结转移、胰腺周围浸润和恶性复发与不良预后相关。多因素分析显示，淋巴结转移是唯一的预后因素（比值比7.5；95%可信区间：3.4至16.4）。与胰腺导管癌患者相比，恶性侵袭性IPMT患者的总体五年生存率更高（36%对21%，p = 0.03），但在II/III期肿瘤亚组中相似。
切除的原位/侵袭性I期恶性IPMT患者的预后极佳。相比之下，局部晚期患者的预后与胰腺导管腺癌患者一样差。
