伴有浸润性癌的导管内乳头状黏液性肿瘤与胰腺导管腺癌相关的导管内乳头状黏液性肿瘤的疾病谱：浸润性 IPMN 与胰腺导管腺癌相关的 IPMN。

Disease spectrum of intraductal papillary mucinous neoplasm with an associated invasive carcinoma invasive IPMN versus pancreatic ductal adenocarcinoma-associated IPMN.

出版信息

Pancreas. 2013 Nov;42(8):1267-74. doi: 10.1097/mpa.0b013e3182954137.

Abstract

OBJECTIVES

Current version of World Health Organization classification introduced the concept of ‘‘intraductal papillary mucinous neoplasm(IPMN) with an associated invasive carcinoma.’’ The authors investigated the clinicopathologic characteristics and prognosis of this disease category according to tumor morphology and percentage of invasive component.

METHODS

Fifty-nine patients who underwent surgical resection of IPMN with an associated invasive carcinoma at Seoul National University Hospital were subgrouped according to the invasive component of less than 5% (minimally invasive [MI] intraductal papillary mucinous carcinoma [IPMC] [MI-IPMC]), 5%- 50% (invasive IPMC [IPMC-I]),and 50% or greater (pancreatic ductal adenocarcinoma [PDAC]-associated IPMN [PDAC-IPMN]). Prognosis was compared with 219 curatively resected conventional PDAC.

RESULTS

Eleven MI-IPMCs (18.6%), 24 IPMC-Is (40.7%), and 24PDAC-IPMNs (40.7%) were identified. With the transition from MIIPMC to IPMC-I and PDAC-IPMN, percentage of advanced T (P G0.001) or N stage (P = 0.001), expression of S100A4 (P = 0.004), p53(P = 0.028), and CD24 (P = 0.009) increased; and SMAD4 expression decreased (P G 0.001). The overall 5-year survival rates for MIIPMC,IPMC-I, and PDAC-IPMN were 80.8%, 59.0%, and 29.3%,respectively (P G 0.001). Pancreatic ductal adenocarcinoma-associated IPMN had poor prognosis compared with MI-IPMC (P = 0.011) or IPMC-I (P = 0.026) but had comparable prognosis with conventional PDAC (P = 0.138).

CONCLUSIONS

Pancreatic ductal adenocarcinoma-associated IPMN has different clinicopathological characteristics compared with the IPMC-I.Intraductal papillary mucinous neoplasm with an associated invasive carcinoma is composed of a wide spectrum of disease.

摘要

目的

世界卫生组织（WHO）目前的分类版本引入了“伴有浸润性癌的导管内乳头状黏液性肿瘤（IPMN）”的概念。作者根据肿瘤形态和浸润成分的百分比，研究了该疾病类别的临床病理特征和预后。

方法

在首尔国立大学医院接受手术切除伴有浸润性癌的 IPMN 的 59 名患者，根据浸润成分小于 5%（微浸润[MI]导管内乳头状黏液性癌[IPMC] [MI-IPMC]）、5%-50%（浸润性 IPMC [IPMC-I]）和 50%或以上（与胰腺导管腺癌[PDAC]相关的 IPMN [PDAC-IPMN]）进行分组。将其与 219 例可治愈性切除的常规 PDAC 进行预后比较。

结果

确定了 11 例 MI-IPMC（18.6%）、24 例 IPMC-Is（40.7%）和 24 例 PDAC-IPMN（40.7%）。随着从 MI-IPMC 向 IPMC-I 和 PDAC-IPMN 的转变，高级 T 期（P G 0.001）或 N 期（P = 0.001）、S100A4 表达（P = 0.004）、p53（P = 0.028）和 CD24（P = 0.009）的百分比增加，SMAD4 表达降低（P G 0.001）。MI-IPMC、IPMC-I 和 PDAC-IPMN 的总体 5 年生存率分别为 80.8%、59.0%和 29.3%（P G 0.001）。与 MI-IPMC（P = 0.011）或 IPMC-I（P = 0.026）相比，PDAC-IPMN 预后较差，但与常规 PDAC（P = 0.138）的预后相当。