Jang Jin-Young, Park Taesung, Lee Selyeong, Kim Yongkang, Lee Seung Yeoun, Kim Sun-Whe, Kim Song-Cheol, Song Ki-Byung, Yamamoto Masakazu, Hatori Takashi, Hirono Seiko, Satoi Sohei, Fujii Tsutomu, Hirano Satoshi, Hashimoto Yasushi, Shimizu Yashuhiro, Choi Dong Wook, Choi Seong Ho, Heo Jin Seok, Motoi Fuyuhiko, Matsumoto Ippei, Lee Woo Jung, Kang Chang Moo, Han Ho-Seong, Yoon Yoo-Seok, Sho Masayuki, Nagano Hiroaki, Honda Goro, Kim Sang Geol, Yu Hee Chul, Chung Jun Chul, Nagakawa Yuichi, Seo Hyung Il, Yamaue Hiroki
*Department of Surgery, Seoul National University College of Medicine, Seoul, Korea †Department of Statistics, Seoul National University College of Natural Sciences, Seoul, Korea ‡Department of Mathematics and Statistics, Sejong University College of Natural Sciences, Seoul, Korea §Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea ¶Department of Surgery, Tokyo Women's Medical University, Institute of Gastroenterology, Tokyo, Japan ||Department of Surgery, International University of Health and Welfare Mita Hospital, Surgery, Tokyo Women's Medical University, Institute of Gastroenterology, Tokyo, Japan **Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan ††Department of Surgery, Kansai Medical University, Moriguchi, Osaka, Japan ‡‡Department of Surgery, Nagoya University, Nagoya, Japan §§Department of Surgery, Hokkaido University, Hokkaido, Japan ¶¶Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan ||||Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan ***Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea †††Department of Surgery, Tohoku University, Tohoku, Japan ‡‡‡Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan §§§Pancreaticobiliary Cancer Clinic, Yonsei University College of Medicine, Yonsei Cancer Center, Severance Hospital, Surgery, Seoul, Korea ¶¶¶Department of Surgery, Seoul National University Bundang Hospital, Surgery, Seoul National University College of Medicine, Seoul, Korea ||||||Department of Surgery, Seoul National University College of Medicine, Surgery, Seoul National University Bundang Hospital, Seoul, Korea ****Department of Surgery, Nara Medical University, Nara, Japan ††††Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan ‡‡‡‡Department of Surgery, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan §§§§Department of Surgery, Kyungpook National University, Daegu, Korea ¶¶¶¶Department of Surgery, Chonbuk National University, Jeonju, Korea ||||||||Department of Surgery, Soonchunhyang University, Asan, Korea *****Department of Surgery, Tokyo Medical University, Tokyo, Japan †††††Department of Surgery, Pusan National University, Pusan, Korea.
Ann Surg. 2017 Dec;266(6):1062-1068. doi: 10.1097/SLA.0000000000001985.
This study evaluated individual risks of malignancy and proposed a nomogram for predicting malignancy of branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) using the large database for IPMN.
Although consensus guidelines list several malignancy predicting factors in patients with BD-IPMN, those variables have different predictability and individual quantitative prediction of malignancy risk is limited.
Clinicopathological factors predictive of malignancy were retrospectively analyzed in 2525 patients with biopsy proven BD-IPMN at 22 tertiary hospitals in Korea and Japan. The patients with main duct dilatation >10 mm and inaccurate information were excluded.
The study cohort consisted of 2258 patients. Malignant IPMNs were defined as those with high grade dysplasia and associated invasive carcinoma. Of 2258 patients, 986 (43.7%) had low, 443 (19.6%) had intermediate, 398 (17.6%) had high grade dysplasia, and 431 (19.1%) had invasive carcinoma. To construct and validate the nomogram, patients were randomly allocated into training and validation sets, with fixed ratios of benign and malignant lesions. Multiple logistic regression analysis resulted in five variables (cyst size, duct dilatation, mural nodule, serum CA19-9, and CEA) being selected to construct the nomogram. In the validation set, this nomogram showed excellent discrimination power through a 1000 times bootstrapped calibration test.
A nomogram predicting malignancy in patients with BD-IPMN was constructed using a logistic regression model. This nomogram may be useful in identifying patients at risk of malignancy and for selecting optimal treatment methods. The nomogram is freely available at http://statgen.snu.ac.kr/software/nomogramIPMN.
本研究评估了分支导管型导管内乳头状黏液性肿瘤（BD-IPMN）的个体恶变风险，并利用IPMN大型数据库提出了一种预测BD-IPMN恶变的列线图。
尽管共识指南列出了BD-IPMN患者的几个恶变预测因素，但这些变量具有不同的预测能力，对恶变风险的个体定量预测有限。
对韩国和日本22家三级医院的2525例经活检证实为BD-IPMN的患者的临床病理因素进行回顾性分析。排除主胰管扩张>10mm及信息不准确的患者。
研究队列包括2258例患者。恶性IPMN定义为高级别异型增生及相关浸润癌。在2258例患者中，986例（43.7%）为低级别异型增生，443例（19.6%）为中级异型增生，398例（17.6%）为高级别异型增生，431例（19.1%）为浸润癌。为构建和验证列线图，患者被随机分为训练集和验证集，良性和恶性病变比例固定。多因素logistic回归分析筛选出5个变量（囊肿大小、导管扩张、壁结节、血清CA19-9和CEA）用于构建列线图。在验证集中，通过1000次自抽样校准测试，该列线图显示出优异的区分能力。
利用logistic回归模型构建了预测BD-IPMN患者恶变的列线图。该列线图可能有助于识别恶变风险患者并选择最佳治疗方法。该列线图可在http://statgen.snu.ac.kr/software/nomogramIPMN免费获取。
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