Li J A, Han X, Fang Y, Zhang L, Lou W H, Xu X F, Wu W C, Kuang T T, Wang D S, Rong Y F
Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wai Ke Za Zhi. 2019 Mar 1;57(3):170-175. doi: 10.3760/cma.j.issn.0529-5815.2019.03.003.
To explore preoperative predictive markers for invasive malignancy in intraductal papillary mucinous neoplasm(IPMN). The retrospective case-controlled study was adopted.Seventy-nine patients who underwent surgery and with pathologically confirmed IPMN from January 2005 to December 2014 at Department of Pancreatic Surgery, Zhongshan Hospital Fudan University were enrolled.Forty-six patients were male and 33 were female,with an average age of (62.9±8.9)years (range:37-82 years).Tumor sites:56 tumors were located at the head of the pancreas,22 were located at the body and tail of the pancreas,and 1 was located across the whole pancreas.Surgical procedures: 51 patients underwent pancreaticoduodenectomy, 22 patients underwent distal pancreatectomy, 4 patients underwent segmental pancreatectomy and 2 patients underwent total pancreatectomy.IPMNs were classified into non-invasive lesions and invasive carcinomas according to the histopathological findings of the tumor.Thirty-two tumors were non-invasive lesions and 47 were invasive carcinomas.The preoperative findings were compared between patients with non-invasive IPMN and patients with invasive carcinoma by univariate analysis using test and χ(2) test accordingly,and factors with statistically significance were subsequently submitted to multivariate analysis. Univariate analysis showed that tumor size0.022), carcinoembryonic antigen(0.012), CA19-9(0.011), lymphocytes(0.034), neutrophil-to-lymphocyte ratio(0.010)and platelet-to-lymphocyte ratio(PLR)(0.004)were predictive markers with statistical significance.Multivariate analysis showed that CA19-9(0.012)and PLR(0.025) were independent predictive markers for invasive malignancy in IPMN.The area under curve of the combination factor of CA19-9 and PLR(0.864) was larger than that of CA19-9(0.806) or PLR(0.685) alone, and all the authentic indicators of the combination factor were better than those of each alone. CA19-9 and PLR are independent predictive markers for invasive malignancy in IPMN.The combination of CA19-9 and PLR has improved efficacy than each alone.
探讨导管内乳头状黏液性肿瘤（IPMN）浸润性恶性肿瘤的术前预测指标。采用回顾性病例对照研究。纳入2005年1月至2014年12月在复旦大学附属中山医院胰腺外科接受手术且病理确诊为IPMN的79例患者。其中男性46例，女性33例，平均年龄（62.9±8.9）岁（范围：37 - 82岁）。肿瘤部位：胰头56例，胰体尾22例，全胰1例。手术方式：胰十二指肠切除术51例，胰体尾切除术22例，节段性胰腺切除术4例，全胰切除术2例。根据肿瘤的组织病理学结果将IPMN分为非侵袭性病变和浸润性癌。非侵袭性病变32例，浸润性癌47例。分别采用t检验和χ²检验对非侵袭性IPMN患者和浸润性癌患者的术前检查结果进行单因素分析，具有统计学意义的因素随后进行多因素分析。单因素分析显示，肿瘤大小（P = 0.022）、癌胚抗原（P = 0.012）、CA19 - 9（P = 0.011）、淋巴细胞（P = 0.034）、中性粒细胞与淋巴细胞比值（P = 0.010）和血小板与淋巴细胞比值（PLR）（P = 0.004）是具有统计学意义的预测指标。多因素分析显示，CA19 - 9（P = 0.012）和PLR（P = 0.025）是IPMN浸润性恶性肿瘤的独立预测指标。CA19 - 9和PLR联合因子的曲线下面积（0.864）大于单独的CA19 - 9（0.806）或PLR（0.685），且联合因子的所有诊断指标均优于各自单独的指标。CA19 - 9和PLR是IPMN浸润性恶性肿瘤的独立预测指标。CA19 - 9和PLR联合使用比单独使用具有更高的效能。
