头部肿块的慢性钙化性胰腺炎恶性肿瘤的预测因素。
Predictors of malignancy in chronic calcific pancreatitis with head mass.
机构信息
Senthilkumar Perumal, Ravichandran Palaniappan, Sastha Ahanatha Pillai, Vimalraj Velayutham, Jeswanth Sathyanesan, Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai 600001, India.
出版信息
World J Gastrointest Surg. 2013 Apr 27;5(4):97-103. doi: 10.4240/wjgs.v5.i4.97.
AIM
To prospectively analyse the clinical, biochemical and radiological characteristics of the mass lesions arising in a background of chronic calcific pancreatitis (CCP).
METHODS
Eighty three patients, who presented with chronic pancreatitis (CP) and a mass lesion in the head of pancreas between February 2005 and December 2011, were included in the study. Patients who were identified to have malignancy underwent Whipple's procedure and patients whose investigations were suggestive of a benign lesion underwent Frey's procedure. Student t-test was used to compare the mean values of imaging findings [common bile duct (CBD), main pancreatic duct (MPD) size] and laboratory data [Serum bilirubin, carbohydrate antigen 19-9 (CA 19-9)] between the groups. Receiver operating characteristic curve (ROC curve) analysis was done to calculate the cutoff valves of serum bilirubin, CA 19-9, MPD and CBD size. The sensitivity, specificity, positive predictive valve (PPV) and negative predictive value (NPV) were calculated using these cut off points. Multivariate analysis was performed using logistic regression model.
RESULTS
The study included 56 men (67.5%) and 27 women (32.5%). Sixty (72.3%) patients had tropical calcific pancreatitis and 23 (27.7%) had alcohol related CCP. Histologically, it was confirmed that 55 (66.3%) of the 83 patients had an inflammatory head mass and 28 (33.7%) had a malignant head mass. The mean age of individuals with benign inflammatory mass and those with malignant mass was 38.4 years and 45 years respectively. Significant clinical features that predicted a malignant head mass in CP were presence of a head mass in CCP of tropics, old age, jaundice, sudden worsening abdominal pain, gastric outlet obstruction and significant weight loss (P ≤ 0.05). The ROC curve analysis showed a cut off value of 5.8 mg/dL for serum bilirubin, 127 U/mL for CA 19-9, 11.5 mm for MPD size and 14.5 mm for CBD size.
CONCLUSION
Elevated Serum bilirubin and CA 19-9, and dilated MPD and CBD were useful in predicting malignancy in patients with CCP and head mass.
目的
前瞻性分析慢性钙化性胰腺炎（CCP）背景下出现的肿块的临床、生化和影像学特征。
方法
2005 年 2 月至 2011 年 12 月期间，83 例因慢性胰腺炎（CP）和胰头部肿块就诊的患者纳入本研究。对被确定为恶性肿瘤的患者行胰十二指肠切除术，对检查提示良性病变的患者行 Frey 手术。采用 Student t 检验比较两组影像学检查[胆总管（CBD）、主胰管（MPD）大小]和实验室数据[血清胆红素、糖链抗原 19-9（CA 19-9）]的均值。采用受试者工作特征曲线（ROC 曲线）分析计算血清胆红素、CA 19-9、MPD 和 CBD 大小的截断值。使用这些截断值计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。采用逻辑回归模型进行多变量分析。
结果
本研究包括 56 名男性（67.5%）和 27 名女性（32.5%）。60 例（72.3%）患者为热带钙化性胰腺炎，23 例（27.7%）为酒精性 CCP。组织学证实，83 例患者中有 55 例（66.3%）为炎症性胰头部肿块，28 例（33.7%）为恶性胰头部肿块。良性炎症性肿块患者和恶性肿块患者的平均年龄分别为 38.4 岁和 45 岁。CP 中存在 CCP 头部肿块、年龄较大、黄疸、腹痛突然加重、胃出口梗阻和明显体重减轻等有临床意义的特征提示恶性头部肿块（P≤0.05）。ROC 曲线分析显示血清胆红素截断值为 5.8mg/dL、CA 19-9 截断值为 127U/mL、MPD 大小截断值为 11.5mm、CBD 大小截断值为 14.5mm。
结论
血清胆红素和 CA 19-9 升高，以及 MPD 和 CBD 扩张有助于预测 CCP 伴头部肿块患者的恶性肿瘤。
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