Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
J Surg Res. 2011 May 15;167(2):251-7. doi: 10.1016/j.jss.2009.05.035. Epub 2009 Jun 21.
Because of the malignant potential, resection has been recommended for some intraductal papillary mucinous neoplasms (IPMN). We hypothesize that a large cancer database could be used to evaluate national resection rates and survival for malignant IPMN.
Using the Surveillance Epidemiology and End Results (SEER) database, 1988-2003, cases of malignant IPMN were identified using histology codes. Age-adjusted incidence rates were calculated; Cochran-Armitage tests evaluated trends over time. Predictors of resection were evaluated using χ(2) and logistic regression. Kaplan-Meier curves and Cox models were constructed to evaluate survival.
Of 1834 patients, 209 (11.4%) underwent resection. Annual age-adjusted incidence decreased over the study time-course (P<0.05), while annual proportion of patients presenting with localized lesions and the proportion being resected increased (P<0.05). Predictors of resection on multivariate analysis included localized stage [versus distant, adjusted odds ratio (OR) 31; 95% confidence interval (CI) 17-56], and more recent diagnosis [referent 1988-1991; 2000-2003, OR 3.0 (95%CI 1.7-5.3)]. Median survival for resected patients was 16 mo versus 3 mo without resection (P<0.0001). After adjusting for age, gender, stage, year, and tumor location, surgical resection remained a significant predictor of survival [hazard ratio 0.44 (95% CI 0.36-0.54), P<0.0001].
In this population-based cohort, detection of malignant IPMNs is decreasing, with an increasing proportion of patients diagnosed at local stages and undergoing resection. Increased awareness of IPMN may be contributing to earlier detection, which might include benign/premalignant lesions, and greater utilization of resection for appropriate candidates; thus, we may be improving survival for this most treatable form of pancreatic cancer.
由于恶性潜能，一些导管内乳头状黏液性肿瘤（IPMN）被推荐进行切除术。我们假设可以使用大型癌症数据库来评估全国范围内恶性 IPMN 的切除率和生存率。
使用监测、流行病学和最终结果（SEER）数据库，1988 年至 2003 年，通过组织学代码确定恶性 IPMN 病例。计算年龄调整发病率；Cochran-Armitage 检验评估随时间的趋势。使用 χ(2)和逻辑回归评估切除术的预测因素。构建 Kaplan-Meier 曲线和 Cox 模型评估生存情况。
在 1834 例患者中，209 例（11.4%）接受了切除术。研究期间，每年的年龄调整发病率呈下降趋势（P<0.05），而局部病变患者的比例和接受切除术的患者比例呈上升趋势（P<0.05）。多变量分析的切除术预测因素包括局部分期[远处转移，调整优势比（OR）31；95%置信区间（CI）17-56]和更近期的诊断[参考 1988-1991 年；2000-2003 年，OR 3.0（95%CI 1.7-5.3]。接受切除术患者的中位生存时间为 16 个月，而未接受切除术患者为 3 个月（P<0.0001）。在调整年龄、性别、分期、年份和肿瘤位置后，手术切除仍然是生存的显著预测因素[风险比 0.44（95%CI 0.36-0.54），P<0.0001]。
在这个基于人群的队列中，恶性 IPMN 的检出率正在下降，局部分期和接受切除术的患者比例也在增加。对 IPMN 的认识增加可能导致更早的发现，这可能包括良性/癌前病变，以及对合适患者更广泛地利用切除术；因此，我们可能正在改善这种最具治疗潜力的胰腺癌的生存率。
