Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Dig Surg. 2012;29(3):213-25. doi: 10.1159/000339334. Epub 2012 Jun 7.
Accurate information is currently lacking regarding the values of positive margins (M(+)) and lymph node (LN) metastases as independent predictors of postoperative recurrence in invasive and noninvasive intraductal papillary mucinous neoplasms (IPMNs) of the pancreas.
A comprehensive online literature search identified all types of primary studies that included M(+) and LN metastases as risk factors and defined recurrence as an outcome in patients with IPMNs. Suitable articles were also identified by manually researching references in qualifying articles. A meta-analysis of the result was performed using a random effects model.
The recurrence rate in noninvasive IPMNs was 3.72% in patients with negative margin (M(-)) versus 9.56% in those with M(+) (odds ratio, OR = 0.37, 95% confidence interval, 95% CI: 0.17-0.78, p = 0.010). The recurrence rate in invasive M(-) IPMNs in was 33.85% compared to 53.66% in M(+) IPMNs (OR = 0.47, 95% CI: 0.25-0.88, p = 0.020). The recurrence rate in invasive IPMNs with positive LN was 76.92% compared to 30.86% with negative LN; OR = 0.15, 95% CI: 0.06-0.37, p < 0.0001).
M(+) were associated with disease recurrence in all patients with IPMN, and nodal metastases were significantly associated with recurrence in invasive IPMN.
目前，关于阳性切缘（M(+)）和淋巴结（LN）转移作为浸润性和非浸润性胰管内乳头状黏液性肿瘤（IPMN）术后复发的独立预测因素的价值，缺乏准确信息。
通过全面的在线文献检索，确定了所有将 M(+)和 LN 转移作为危险因素，并将复发定义为 IPMN 患者结局的原发性研究。通过手动研究合格文章中的参考文献，也确定了合适的文章。使用随机效应模型对结果进行荟萃分析。
在 M(-)的非浸润性 IPMN 患者中，复发率为 3.72%，而在 M(+)的患者中为 9.56%（比值比，OR = 0.37，95%置信区间，95%CI：0.17-0.78，p = 0.010）。在 M(-)的浸润性 IPMN 患者中，复发率为 33.85%，而在 M(+)的患者中为 53.66%（OR = 0.47，95%CI：0.25-0.88，p = 0.020）。LN 阳性的浸润性 IPMN 患者的复发率为 76.92%，而 LN 阴性的复发率为 30.86%；OR = 0.15，95%CI：0.06-0.37，p < 0.0001）。
M(+)与所有 IPMN 患者的疾病复发相关，而淋巴结转移与浸润性 IPMN 的复发显著相关。
