Nakagohri Toshio, Kinoshita Taira, Konishi Masaru, Takahashi Shinichiro, Gotohda Naoto
Department of Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan.
Ann Surg Oncol. 2007 Nov;14(11):3174-80. doi: 10.1245/s10434-007-9546-x. Epub 2007 Aug 12.
An increasing number of intraductal papillary mucinous neoplasms of the pancreas have been reported in recent years. However, the clinicopathologic features and surgical outcome of this neoplasm are not fully understood because of the limited number of cases. The objective of this study is to clarify the clinicopathologic features of intraductal papillary mucinous neoplasm of the pancreas and evaluate prognostic factors influencing survival.
Eighty-two patients with intraductal papillary mucinous neoplasm undergoing surgical resection at the National Cancer Center Hospital East between April 1994 and October 2006 were retrospectively analyzed.
There were 31 patients with adenoma and 51 patients with carcinoma. Carcinomas were subdivided into noninvasive carcinoma (n = 14), minimally invasive carcinoma (n = 6), and invasive carcinoma (n = 31). The postoperative mortality rate was 0%. The 5-year survival rate for patients with intraductal papillary mucinous adenoma, noninvasive carcinoma, minimally invasive carcinoma, and invasive carcinoma was 80%, 78%, 83%, and 24%, respectively. Regardless of the margin status, no patient with adenoma developed recurrent disease. There were significant differences in survival between noninvasive carcinoma and invasive carcinoma (P = .016) and between minimally invasive carcinoma and invasive carcinoma (P = .030). Multivariate analysis confirmed that lymph node metastasis (P = .004) and age (P = .015) were significant prognostic factors after surgical resection of these neoplasms.
Patients with intraductal papillary mucinous adenoma, noninvasive carcinoma, and minimally invasive carcinoma showed favorable survival. In contrast, invasive intraductal papillary mucinous carcinoma was associated with poor survival regardless of the margin status. Nodal involvement was the strongest predictor of poor survival.
近年来，胰腺导管内乳头状黏液性肿瘤的报道日益增多。然而，由于病例数量有限，该肿瘤的临床病理特征及手术结果尚未完全明确。本研究的目的是阐明胰腺导管内乳头状黏液性肿瘤的临床病理特征，并评估影响生存的预后因素。
回顾性分析1994年4月至2006年10月在国立癌症中心东医院接受手术切除的82例胰腺导管内乳头状黏液性肿瘤患者。
腺瘤患者31例，癌患者51例。癌又分为非浸润性癌（n = 14）、微浸润性癌（n = 6）和浸润性癌（n = 31）。术后死亡率为0%。胰腺导管内乳头状黏液性腺瘤、非浸润性癌、微浸润性癌和浸润性癌患者的5年生存率分别为80%、78%、83%和24%。无论切缘情况如何，腺瘤患者均未发生复发性疾病。非浸润性癌与浸润性癌之间（P = .016）以及微浸润性癌与浸润性癌之间（P = .030）的生存率存在显著差异。多因素分析证实，淋巴结转移（P = .004）和年龄（P = .015）是这些肿瘤手术切除后的重要预后因素。
胰腺导管内乳头状黏液性腺瘤、非浸润性癌和微浸润性癌患者的生存率良好。相比之下，无论切缘情况如何，浸润性胰腺导管内乳头状黏液癌的生存率都较差。淋巴结受累是生存率差的最强预测因素。
