Niedergethmann Marco, Grützmann Robert, Hildenbrand Ralf, Dittert Dag, Aramin Niloufar, Franz Melanie, Dobrowolski Frank, Post Stefan, Saeger Hans-Detlev
Department of Surgery, University-Hospital Mannheim, Faculty of Medicine Mannheim/University of Heidelberg, Mannheim, Germany.
World J Surg. 2008 Oct;32(10):2253-60. doi: 10.1007/s00268-008-9692-8.
Intraductal papillary-mucinous neoplasms (IPMN) were officially introduced into the TNM classification in 1996. Based on a two-center database, we reevaluated histopathological findings, clinicopathological pattern, predictive markers for malignancy, and outcome.
Between 1996 and 2006, a total of 1424 pancreatic resections were performed in the University Hospitals Dresden and Mannheim. Pathologists of both institutions reviewed the IPMN diagnoses and other with cystic or solid tumor diagnoses. All possible markers, such as diabetes, jaundice, etc., were analyzed for prediction of malignancy. We performed a survival analysis based on the morphologic classification to determine the prognosis of IPMN.
There were 43 patients of primarily diagnosed IPMN along with 1174 patients with diagnoses, such as ductal adenocarcinoma. In 207 patients, the diagnoses revealed other cystic or small solid tumors. A histopathological review of the latter patients revealed 54 IPMNs, resulting in a total of 97 IPMN patients (29 noninvasive, 68 invasive). All IPMN patients had a median survival of 36 months. Recurrence occurred more frequently in invasive IPMN. Predictive markers of malignancy were pain, preoperative weight loss, jaundice, and elevated CA 19.9. The strongest independent prognostic factor was invasive growth. The survival analysis revealed excellent prognosis for noninvasive IPMN.
Since the introduction of IPMN in 1996, even specialized centers have had to deal with a learning curve. By reevaluating all cystic or small solid tumors, centers can improve and their patients' treatment can be optimized. Because the preoperative diagnostic methods are not sensitive enough to differentiate between benign and malignant lesions, surgery is advocated for all main duct IPMN, because they have a high malignant potential. For branch duct IPMN, surgery is advocated if the lesion is symptomatic, >3 cm, or has enlarged nodules.
导管内乳头状黏液性肿瘤（IPMN）于1996年正式纳入TNM分类。基于两个中心的数据库，我们重新评估了组织病理学发现、临床病理模式、恶性肿瘤预测标志物及预后。
1996年至2006年期间，德累斯顿和曼海姆大学医院共进行了1424例胰腺切除术。两所机构的病理学家复查了IPMN诊断及其他囊性或实性肿瘤诊断。分析所有可能的标志物，如糖尿病、黄疸等，以预测恶性肿瘤。我们基于形态学分类进行生存分析，以确定IPMN的预后。
最初诊断为IPMN的患者有43例，另有1174例诊断为导管腺癌等疾病。在207例患者中，诊断显示为其他囊性或小实性肿瘤。对后一组患者的组织病理学复查发现54例IPMN，从而使IPMN患者总数达到97例（29例非侵袭性，68例侵袭性）。所有IPMN患者的中位生存期为36个月。侵袭性IPMN复发更频繁。恶性肿瘤的预测标志物为疼痛、术前体重减轻、黄疸和CA 19.9升高。最强的独立预后因素是侵袭性生长。生存分析显示非侵袭性IPMN预后良好。
自1996年引入IPMN以来，即使是专业中心也必须应对学习曲线。通过重新评估所有囊性或小实性肿瘤，各中心可以改进，患者的治疗也可得到优化。由于术前诊断方法对区分良性和恶性病变不够敏感，对于所有主胰管IPMN均主张手术治疗，因为它们具有较高的恶性潜能。对于分支胰管IPMN，如果病变有症状、直径>3 cm或有增大的结节，则主张手术治疗。
