Ateeb Zeeshan, Valente Roberto, Pozzi-Mucelli Raffaella M, Malgerud Linnéa, Schlieper Yasmine, Rangelova Elena, Fernandez-Moro Carlos, Löhr Johannes Matthias, Arnelo Urban, Del Chiaro Marco
Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
Digestive and Liver Diseases Unit, Sapienza University of Rome, Rome, Italy.
Langenbecks Arch Surg. 2019 Feb;404(1):31-37. doi: 10.1007/s00423-018-1740-8. Epub 2019 Jan 5.
IPMNs, considered precursor lesions of pancreatic adenocarcinoma (PDAC), might display histological alteration varying from low-grade dysplasia (LGD) to cancer. Nevertheless, the prevalence of PDAC is far below the prevalence of IPMN; therefore, not all of these precursor lesions finally progress to cancer. Preoperative features consistent with and finding at final histology of high-grade dysplasia (HGD) or cancer are currently lacking. The aim of this study is to correlate the presence of preoperative clinical features with the finding of advance lesions at final histology.
This is retrospective cohort analysis of patients who underwent surgery for histologically confirmed IPMNs at Karolinska University Hospital, from 2008 to 2015.
MPD 6-9.9 mm and ≥ 10 mm were associated with an increased risk of HGD/cancer (respectively, OR 2.92, CI 1.38-6.20, p = 0.005 and OR 2.65, CI 1.12-6.25, p = 0.02). Preoperative high CA19.9 and jaundice were both associated with a higher risk of HGD/cancer at final histology (respectively, OR 4.15, CI 1.90-9.05, p = 0.0003 and OR 15.36, CI 1.94-121.22, p = 0.009). At sex- and age-adjusted multivariable logistic regression analysis, MPD between 6 and 9.9 mm (OR 2.64, CI 1.15-6.06, p = 0.02), jaundice (OR 12.43, CI 1.44-106.93, p = 0.02), and elevated CA19.9 (OR 3.71, CI 1.63-8.46, p = 0.001) remained associated with the occurrence of HGD/cancer.
The presence of MPD dilation ≥ 6 mm, jaundice, and elevated CA19.9 in IPMN patients are consistent with the finding for HGD/cancer at final histology, thus representing possible markers of advanced lesions suitable for earlier or preventive curative surgical treatment.
胰腺导管内乳头状黏液性肿瘤（IPMN）被认为是胰腺腺癌（PDAC）的前驱病变，其组织学改变可能从低级别异型增生（LGD）到癌症不等。然而，PDAC的患病率远低于IPMN的患病率；因此，并非所有这些前驱病变最终都会发展为癌症。目前缺乏与高级别异型增生（HGD）或癌症的最终组织学表现相符的术前特征。本研究的目的是将术前临床特征的存在与最终组织学检查中进展期病变的发现相关联。
这是一项对2008年至2015年在卡罗林斯卡大学医院接受手术治疗且组织学确诊为IPMN的患者的回顾性队列分析。
主胰管直径（MPD）6 - 9.9毫米和≥10毫米与HGD/癌症风险增加相关（分别为：比值比[OR] 2.92，置信区间[CI] 1.38 - 6.20，p = 0.005；以及OR 2.65，CI 1.12 - 6.25，p = 0.02）。术前高CA19.9和黄疸均与最终组织学检查中HGD/癌症的较高风险相关（分别为：OR 4.15，CI 1.90 - 9.05，p = 0.0003；以及OR 15.36，CI 1.94 - 121.22，p = 0.009）。在进行性别和年龄调整的多变量逻辑回归分析中，MPD在6至9.9毫米之间（OR 2.64，CI 1.15 - 6.06，p = 0.02）、黄疸（OR 12.43，CI 1.44 - 106.93，p = 0.02）和CA19.9升高（OR 3.71，CI 1.63 - 8.46，p = 0.001）仍与HGD/癌症的发生相关。
IPMN患者中存在MPD扩张≥6毫米、黄疸和CA19.9升高与最终组织学检查中HGD/癌症的表现相符，因此代表了适合早期或预防性根治性手术治疗的进展期病变的可能标志物。
