Tabrizian Parissa, Berger Yaniv, Pierobon Elisa Sefora, Aycart Samantha, Argiriadi Pamela, Fei Kezhen, Carrasco-Avino Gonzalo, Labow Daniel M, Sarpel Umut
From the *Recanati-Miller Transplantation Institute; Departments of †Surgery, Division of Surgical Oncology, ‡Radiology, §Health Evidence and Policy, Center for Biostatistics, and ∥Pathology, Icahn School of Medicine at Mount Sinai, New York, NY.
Pancreas. 2017 Feb;46(2):198-202. doi: 10.1097/MPA.0000000000000747.
This study aimed to determine how frequently guidelines for the management of intraductal papillary mucinous neoplasms (IPMNs) are followed and establish factors associated with failure.
Four hundred forty-five patients with radiographic diagnosis of IPMN 1 cm or greater between January 1, 2003 and January 1, 2013 were included. We defined failure of guideline adherence if the following occurred: (a) failure of acknowledgment of IPMN, (b) failure to undergo endoscopic ultrasound, (c) failure to undergo resection, or (d) failure to undergo at least 1 surveillance image within 2 years after diagnosis.
Failure of guideline adherence was observed in 58% of patients and evident across all the respective criteria (A: 38%, B: 25%, C: 29%, D: 33%). Age older than 68 years (P < 0.01), American Society of Anesthesiologists score of 3 or higher (P < 0.0001), benign findings on imaging (P < 0.0001), and major comorbid conditions (P < 0.01) were factors associated with higher rate of failure to compliance. On multivariate logistic regression, American Society of Anesthesiologists score of 3 or higher and benign features were associated with 4.0 times (95% confidence interval, 2.02-8.06) and 2.6 times (95% confidence interval, 1.60-4.07) higher odds of failure to compliance with guidelines, respectively.
Compliance with clinical guidelines for the management of IPMN is poor. Socioeconomic factors do not seem to create a disparity to care. However, many patients with IPMN have other medical diagnoses that take priority over IPMN surveillance and treatment.
本研究旨在确定导管内乳头状黏液性肿瘤（IPMN）管理指南的遵循频率，并确定与未遵循相关的因素。
纳入2003年1月1日至2013年1月1日期间影像学诊断为IPMN且直径≥1 cm的445例患者。如果发生以下情况，我们定义为未遵循指南：（a）未确认IPMN；（b）未接受内镜超声检查；（c）未接受手术切除；或（d）诊断后2年内未接受至少1次监测影像检查。
58%的患者存在未遵循指南的情况，且在所有各自标准中均很明显（A：38%，B：25%，C：29%，D：33%）。年龄大于68岁（P<0.01）、美国麻醉医师协会评分3分或更高（P<0.0001）、影像学检查结果为良性（P<0.0001）以及存在主要合并症（P<0.01）是与较高未遵循率相关的因素。在多因素逻辑回归分析中，美国麻醉医师协会评分3分或更高以及良性特征分别与未遵循指南的较高几率相关，几率分别高出4.0倍（95%置信区间，2.02 - 8.06）和2.6倍（95%置信区间，1.60 - 4.07）。
IPMN管理临床指南的遵循情况较差。社会经济因素似乎并未造成护理差异。然而，许多IPMN患者有其他医学诊断，这些诊断优先于IPMN的监测和治疗。
