Kang Jae Seung, Park Taesung, Han Youngmin, Lee Seungyeon, Lim Heeju, Kim Hyeongseok, Kim Se Hyung, Kwon Wooil, Kim Sun-Whe, Jang Jin-Young
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Department of Statistics and Interdisciplinary Program in Biostatistics, Seoul National University, Seoul, Korea.
Ann Surg Treat Res. 2019 Aug;97(2):58-64. doi: 10.4174/astr.2019.97.2.58. Epub 2019 Jul 29.
The 2017 international consensus guidelines (ICG) for intraductal papillary mucinous neoplasm (IPMN) of the pancreas were recently released. Important changes included the addition of worrisome features such as elevated serum CA 19-9 and rapid cyst growth (>5 mm over 2 years). We aimed to clinically validate the 2017 ICG and compare the diagnostic performance between the 2017 and 2012 ICG.
This was a retrospective cohort study. During January 2000-January 2017, patients who underwent complete surgical resection and had pathologic confirmation of branch-duct or mixed-type IPMN were included. To evaluate diagnostic performance, the areas under the receiver operating curves (AUCs) were evaluated.
A total of 448 patients were included. The presence of mural nodule (hazard ratio [HR], 9.12; 95% confidence interval [CI], 4.60-18.09; P = 0.001), main pancreatic duct dilatation (>5 mm) (HR, 5.32; 95% CI, 2.67-10.60; P = 0.001), thickened cystic wall (HR, 3.40; 95% CI, 1.51-7.63; P = 0.003), and elevated CA 19-9 level (>37 unit/mL) (HR, 5.25; 95% CI, 2.05-13.42; P = 0.001) were significantly associated with malignant IPMN. Malignant lesions showed a cyst growth rate >5 mm over 2 years more frequently than benign lesions (60.9% vs. 29.7%, P = 0.012). The AUC was higher for the 2017 ICG than the 2012 ICG (0.784 vs. 0.746).
The new 2017 ICG for IPMN is clinically valid, with a superior diagnostic performance to the 2012 ICG. The inclusion of elevated serum CA 19-9 level and cyst growth rate to the 2017 ICG is appropriate.
胰腺导管内乳头状黏液性肿瘤（IPMN）的2017年国际共识指南（ICG）近期发布。重要变化包括增加了一些令人担忧的特征，如血清CA 19-9升高和囊肿快速生长（2年内>5 mm）。我们旨在对2017年ICG进行临床验证，并比较2017年和2012年ICG的诊断性能。
这是一项回顾性队列研究。纳入2000年1月至2017年1月期间接受完整手术切除且病理证实为分支导管型或混合型IPMN的患者。为评估诊断性能，对受试者工作曲线下面积（AUC）进行评估。
共纳入448例患者。壁结节的存在（风险比[HR]，9.12；95%置信区间[CI]，4.60-18.09；P = 0.001）、主胰管扩张（>5 mm）（HR，5.32；95%CI，2.67-10.60；P = 0.001）、囊壁增厚（HR，3.40；95%CI，1.51-7.63；P = 0.003）以及CA 19-9水平升高（>37单位/mL）（HR，5.25；95%CI，2.05-13.42；P = 0.001）与恶性IPMN显著相关。恶性病变2年内囊肿生长速度>5 mm的频率高于良性病变（60.9%对29.7%，P = 0.012）。2017年ICG的AUC高于2012年ICG（0.784对0.746）。
新的2017年IPMN ICG在临床上是有效的，其诊断性能优于2012年ICG。将血清CA 19-9水平升高和囊肿生长速度纳入2017年ICG是合适的。
