Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea.
World J Surg. 2010 Apr;34(4):776-83. doi: 10.1007/s00268-010-0416-5.
The objective of the present study was to identify reliable preoperative factors predicting malignancy or invasiveness of intraductal papillary mucinous neoplasm (IPMN) of the pancreas and the effectiveness of a diagnostic scoring system based on these factors.
Between August 1994 and December 2007, 204 patients underwent pancreatic resection for IPMN at a single institute. Medical records were reviewed retrospectively, and a new diagnostic scoring system for predicting malignant IPMN preoperatively was designed.
Univariate analysis revealed nine significant predictors of both malignant and invasive IPMN: age > or =60 years, history of pancreatitis, presence of mural nodule(s), diameter of main pancreatic duct (MPD) >6 mm, main duct or mixed type, total bilirubin >1.2 mg/dl, CA-19-9 >37 U/ml, tumor location in the pancreatic head, and tumor size >30 mm. Multivariate analysis showed that age, pancreatitis, mural nodule(s), and MPD diameter were independent predictors of invasive IPMN, and that all these parameters, plus elevated carbohydrate antigen-19-9 (CA-19-9), were independent predictors of malignant IPMN. A scoring system based on these five factors, each assigned 1 point, and with a cut-off of 3 points, could predict malignant IPMN with a sensitivity of 50.7% and a specificity of 90.1%. The 5-year survival rates of patients with benign and malignant IPMN were 95.0% and 64.0%, respectively.
Our scoring system using five independent factors (age > or =60 years, history of pancreatitis, presence of mural nodule(s), elevated level of CA-19-9, and MPD diameter >6 mm) may be helpful for predicting malignancy and postoperative survival.
本研究的目的是确定术前可靠的预测因素，以识别胰腺内乳头状黏液性肿瘤（IPMN）的恶性或侵袭性，并评估基于这些因素的诊断评分系统的有效性。
1994 年 8 月至 2007 年 12 月期间，单中心 204 例患者因 IPMN 接受胰腺切除术。回顾性分析病历资料，并设计了一种新的术前预测恶性 IPMN 的诊断评分系统。
单因素分析显示 9 个因素与恶性和侵袭性 IPMN 相关：年龄≥60 岁、胰腺炎病史、存在壁结节、主胰管（MPD）直径>6mm、主胰管或混合性、总胆红素>1.2mg/dl、CA-19-9>37U/ml、肿瘤位于胰头部和肿瘤大小>30mm。多因素分析显示，年龄、胰腺炎、壁结节和 MPD 直径是侵袭性 IPMN 的独立预测因素，而所有这些参数加上 CA-19-9 升高是恶性 IPMN 的独立预测因素。基于这 5 个因素的评分系统，每个因素赋值 1 分，总分≥3 分可预测恶性 IPMN，其敏感性为 50.7%，特异性为 90.1%。良性和恶性 IPMN 患者的 5 年生存率分别为 95.0%和 64.0%。
我们的评分系统使用 5 个独立因素（年龄≥60 岁、胰腺炎病史、存在壁结节、CA-19-9 升高和 MPD 直径>6mm）可有助于预测恶性和术后生存。
