Department of Surgery, Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA.
Ann Surg. 2010 Mar;251(3):470-6. doi: 10.1097/SLA.0b013e3181cf8a19.
To identify pathologic features that may account for the favorable survival after resection of invasive pancreatic adenocarcinoma arising in the setting of intraductal papillary mucinous neoplasm (IPMN) compared with standard pancreatic ductal adenocarcinoma (PDA) in the absence of IPMN.
The 5-year survival after resection of IPMN-associated invasive adenocarcinoma is reported to be between 40% and 60%, which is superior to the 10-25%, typically cited after resection of standard PDA. It remains unclear whether this represents distinct biology or simply a tendency for earlier presentation of IPMN-associated invasive adenocarcinoma.
A single institution's prospective pancreatic resection database was retrospectively reviewed to identify patients with invasive pancreatic adenocarcinoma who underwent pancreatectomy with curative intent. Log rank and Cox regression analysis were used to identify factors associated with survival.
From 1995 to 2006, 1260 consecutive patients were identified, 132 (10%) with IPMN-associated invasive adenocarcinoma and 1128 (90%) with standard PDA. Actuarial 5-year survival was 42% after resection for IPMN-associated versus 19% for standard PDA (P < 0.001). However, compared with standard PDA, invasive adenocarcinoma arising within an IPMN was associated with a lower incidence of (1) advanced T stage (T2-T4, 96% vs. 73%, P < 0.001); (2) regional lymph node metastasis (78% vs. 51%, P < 0.001); (3) poor tumor differentiation (44% vs. 26%, P < 0.001); (4) vascular invasion (54% vs. 33%, P < 0.001); (5) perineural invasion (92% vs. 63%, P < 0.001); and (6) microscopic margin involvement (28% vs. 14%, P < 0.001). Specifically, in the presence of any one of the aforementioned adverse pathologic characteristics, outcomes after resection for IPMN-associated and standard PDA were not significantly different.
The favorable biologic behavior of IPMN-associated compared with standard PDA is based on its lower rate of advanced T stage, lymph node metastasis, high tumor grade, positive resection margin, perineural, and vascular invasion. In the presence of any one of the aforementioned adverse pathologic characteristics, however, survival outcomes after resection of IPMN-associated and after resection of standard pancreatic adenocarcinoma are similar.
确定在没有胰管内乳头状黏液性肿瘤（IPMN）的情况下，与标准胰腺导管腺癌（PDA）相比，在切除起源于 IPMN 的浸润性胰腺腺癌后，可能导致生存结果改善的病理特征。
据报道，切除伴 IPMN 的浸润性胰腺腺癌后 5 年生存率为 40%至 60%，优于标准 PDA 切除后通常报告的 10%至 25%。目前尚不清楚这是否代表不同的生物学特性，还是仅仅代表 IPMN 相关浸润性胰腺腺癌的早期表现趋势。
回顾性分析单机构前瞻性胰腺切除术数据库，以确定接受根治性胰腺切除术的浸润性胰腺腺癌患者。对数秩和 Cox 回归分析用于确定与生存相关的因素。
1995 年至 2006 年，共确定了 1260 例连续患者，其中 132 例（10%）为伴 IPMN 的浸润性胰腺腺癌，1128 例（90%）为标准 PDA。伴 IPMN 的浸润性胰腺腺癌切除后 5 年生存率为 42%，而标准 PDA 为 19%（P < 0.001）。然而，与标准 PDA 相比，起源于 IPMN 的浸润性腺癌与以下情况的发生率较低有关：（1）较晚的 T 分期（T2-T4，96% vs. 73%，P < 0.001）；（2）区域淋巴结转移（78% vs. 51%，P < 0.001）；（3）肿瘤分化较差（44% vs. 26%，P < 0.001）；（4）血管侵犯（54% vs. 33%，P < 0.001）；（5）神经周围侵犯（92% vs. 63%，P < 0.001）；和（6）显微镜下切缘受累（28% vs. 14%，P < 0.001）。具体而言，在存在上述任何一种不良病理特征的情况下，伴 IPMN 和标准 PDA 切除后的结局无显著差异。
与标准 PDA 相比，伴 IPMN 的胰腺腺癌具有较好的生物学行为，这是基于其较低的晚期 T 分期、淋巴结转移、高肿瘤分级、阳性切缘、神经周围和血管侵犯发生率。然而，在存在上述任何一种不良病理特征的情况下，伴 IPMN 和标准胰腺腺癌切除后的生存结果相似。
