Attiyeh Marc A, Fernández-Del Castillo Carlos, Al Efishat Mohammad, Eaton Anne A, Gönen Mithat, Batts Ruqayyah, Pergolini Ilaria, Rezaee Neda, Lillemoe Keith D, Ferrone Cristina R, Mino-Kenudson Mari, Weiss Matthew J, Cameron John L, Hruban Ralph H, D'Angelica Michael I, DeMatteo Ronald P, Kingham T Peter, Jarnagin William R, Wolfgang Christopher L, Allen Peter J
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Ann Surg. 2018 Jan;267(1):157-163. doi: 10.1097/SLA.0000000000002015.
Previous nomogram models for patients undergoing resection of intraductal papillary mucinous neoplasms (IPMNs) have been relatively small single-institutional series. Our objective was to improve upon these studies by developing and independently validating a new model using a large multiinstitutional dataset.
IPMNs represent the most common radiographically identifiable precursor lesions of pancreatic cancer. They are a heterogenous group of neoplasms in which more accurate markers of high-grade dysplasia or early invasive carcinoma could help avoid unnecessary surgery in 1 case and support potentially curative intervention (resection) in another.
Prospectively maintained databases from 3 institutions were queried for patients who had undergone resection of IPMNs between 2005 and 2015. Patients were separated into main duct [main and mixed-type (MD)] and branch duct (BD) types based on preoperative imaging. Logistic regression modeling was used on a training subset to develop 2 independent nomograms (MD and BD) to predict low-risk (low- or intermediate-grade dysplasia) or high-risk (high-grade dysplasia or invasive carcinoma) disease. Model performance was then evaluated using an independent validation set.
We identified 1028 patients who underwent resection for IPMNs [MD: n = 454 (44%), BD: n = 574 (56%)] during the 10-year study period. High-risk disease was present in 487 patients (47%). Patients with high-risk disease comprised 71% and 29% of MD and BD groups, respectively (P <0.0001). MD and BD nomograms were developed on the training set [70% of total (n = 720); MD: n = 318, BD: n = 402] and validated on the test set [30% (n = 308); MD: n = 136, BD: n = 172]. The presence of jaundice was almost exclusively associated with high-risk disease (57 of 58 patients, 98%). Cyst size >3.0 cm, solid component/mural nodule, pain symptoms, and weight loss were significantly associated with high-risk disease. C-indices were 0.82 and 0.81 on training and independent validation sets, respectively; Brier scores were 0.173 and 0.175, respectively.
For patients with suspected IPMNs, we present an independently validated model for the prediction of high-risk disease.
既往用于导管内乳头状黏液性肿瘤（IPMN）切除患者的列线图模型相对较小，均为单机构系列研究。我们的目标是通过使用大型多机构数据集开发并独立验证一个新模型来改进这些研究。
IPMN是胰腺癌最常见的影像学可识别的前驱病变。它们是一组异质性肿瘤，其中更准确的高级别异型增生或早期浸润癌标志物有助于在一种情况下避免不必要的手术，并在另一种情况下支持可能治愈性的干预（切除）。
查询了3家机构前瞻性维护的数据库，以获取2005年至2015年间接受IPMN切除的患者。根据术前影像学检查，将患者分为主胰管[主胰管型和混合型（MD）]和分支胰管（BD）型。在一个训练子集中使用逻辑回归模型开发2个独立的列线图（MD和BD），以预测低风险（低级别或中级别异型增生）或高风险（高级别异型增生或浸润癌）疾病。然后使用独立验证集评估模型性能。
在10年研究期间，我们确定了1028例接受IPMN切除的患者[MD：n = 454（44%），BD：n = 574（56%）]。487例患者（47%）存在高风险疾病。高风险疾病患者分别占MD组和BD组的71%和29%（P <0.0001）。在训练集[占总数的70%（n = 720）；MD：n = 318，BD：n = 402]上开发了MD和BD列线图，并在测试集[30%（n = 308）；MD：n = 136，BD：n = 172]上进行了验证。黄疸的出现几乎仅与高风险疾病相关（58例患者中的57例，98%）。囊肿大小>3.0 cm、实性成分/壁结节、疼痛症状和体重减轻与高风险疾病显著相关。训练集和独立验证集的C指数分别为0.82和0.81；Brier评分分别为0.173和0.175。
对于疑似IPMN的患者，我们提出了一个经独立验证的高风险疾病预测模型。
