Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, 464-8681, Japan.
World J Surg. 2010 Dec;34(12):2932-8. doi: 10.1007/s00268-010-0785-9.
The objective of the present study was to use clinical and laboratory data to develop a model for predicting the presence of carcinoma in patients with intraductal papillary mucinous neoplasm (IPMN).
Data were collected on 81 patients with IPMN who underwent a pancreatic resection between 1989 and 2008 at Aichi Cancer Center Hospital. Variables analyzed included age, gender, laboratory findings (serum amylase, carcinoembryonic antigen, and carbohydrate antigen 19-9 level), pancreatic juice cytology grade, and imaging studies. Factors associated with the presence of carcinoma were evaluated by univariate and multivariate logistic regression analysis.
Among the 81 patients with IPMN, 34 (42%) had malignant tumors (noninvasive carcinoma in 22 and invasive carcinoma in 12), and 47 (58%) had adenoma. On multivariate analysis, existing carcinoma was associated with female gender, main pancreatic duct IPMN, nodule size, and pancreatic juice cytology grade. Based on these variables, a predictive nomogram was developed. The area under the receiver operating characteristic curve (AUC) for the model was 0.903. The sensitivity and specificity of the model were 97.1 and 68.1%, respectively, in the validation study, for which the predictive probability of >10% was used to indicate the presence of carcinoma.
The nomogram has high diagnostic predictability for carcinoma in patients with IPMN and for individual cancer probability. This instrument may help to identify patients who need a surgical procedure.
本研究的目的是利用临床和实验室数据为患者建立预测模型，以便对患有胰管内乳头状黏液性肿瘤（IPMN）的患者是否存在癌进行预测。
收集了 1989 年至 2008 年在爱知县癌症中心医院接受胰腺切除术的 81 例 IPMN 患者的数据。分析的变量包括年龄、性别、实验室检查（血清淀粉酶、癌胚抗原和碳水化合物抗原 19-9 水平）、胰液细胞学分级和影像学研究。通过单因素和多因素逻辑回归分析评估与癌存在相关的因素。
在 81 例 IPMN 患者中，34 例（42%）存在恶性肿瘤（22 例为非浸润性癌，12 例为浸润性癌），47 例（58%）为腺瘤。多因素分析显示，存在癌与女性、主胰管 IPMN、结节大小和胰液细胞学分级有关。基于这些变量，开发了一个预测列线图。模型的受试者工作特征曲线下面积（AUC）为 0.903。验证研究中，该模型的敏感性和特异性分别为 97.1%和 68.1%，用于指示癌存在的预测概率>10%。
该列线图对 IPMN 患者的癌和个体癌症概率具有较高的诊断预测能力。该工具可能有助于识别需要手术的患者。
