胰腺导管内乳头状黏液性肿瘤患者欧洲循证临床实践指南手术适应证的验证。
Validation of Indications for Surgery of European Evidence-Based Guidelines for Patients with Pancreatic Intraductal Papillary Mucinous Neoplasms.
机构信息
Department of Laboratory Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
出版信息
J Gastrointest Surg. 2020 Nov;24(11):2536-2543. doi: 10.1007/s11605-019-04420-9.
BACKGROUND
Which patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) should undergo surgical intervention remains a controversial issue. The aim of this retrospective study was to validate the new European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) for the management of IPMNs.
METHODS
One hundred fifty-eight patients with resected IPMNs at National Taiwan University Hospital between January 1994 and December 2016 were enrolled. Clinical information, including new-onset diabetes mellitus (DM) and preoperative CA 19-9 levels, were collected. All patients were stratified into three groups-absolute, relative indications, and conservative approach-according to EEBGPCN. The performance characteristics of EEBGPCN for high-grade dysplasia (HGD)/invasive carcinoma (IC) of IPMNs were calculated.
RESULTS
One hundred seven (67.7%) patients with low-grade dysplasia and 51 patients with HGD/IC, including 10 HGD and 41 IC, were analyzed. The missed rate for HGD/IC by EEBGPCN was 1.9% (3/158). The sensitivity, specificity, positive and negative predictive values, and accuracy of the absolute or relative indications for resecting IPMN according to EEBGPCN were 94.1%, 28.0%, 38.4%, 90.9%, and 49.4%. Jaundice, enhancing mural nodule < 5 mm, cyst diameter > 40 mm, increased levels of serum CA 19-9, new-onset DM, and main pancreatic duct dilation were associated with HGD/IC.
CONCLUSIONS
The missed rate for HGD/IC is low by EEBGPCN. Increased serum CA 19-9 and new-onset DM in EEBGPCN were verified as the indications for the surgical resection of IPMNs.
背景
哪些胰腺导管内乳头状黏液性肿瘤（IPMNs）患者需要接受手术干预仍然是一个有争议的问题。本回顾性研究的目的是验证新的欧洲基于证据的胰腺囊性肿瘤管理指南（EEBGPCN）在 IPMNs 管理中的作用。
方法
我们纳入了 1994 年 1 月至 2016 年 12 月在国立台湾大学医院接受手术切除的 158 例 IPMNs 患者。收集了包括新发糖尿病（DM）和术前 CA 19-9 水平在内的临床资料。所有患者均根据 EEBGPCN 分为三组——绝对、相对适应证和保守治疗。计算了 EEBGPCN 对 IPMNs 高级别异型增生（HGD）/浸润性癌（IC）的诊断性能。
结果
我们分析了 107 例低级别异型增生和 51 例 HGD/IC 患者，其中包括 10 例 HGD 和 41 例 IC。EEBGPCN 漏诊 HGD/IC 的比例为 1.9%（3/158）。根据 EEBGPCN，绝对或相对适应证切除 IPMN 的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 94.1%、28.0%、38.4%、90.9%和 49.4%。黄疸、强化壁结节＜5mm、囊肿直径＞40mm、血清 CA 19-9 水平升高、新发 DM 和主胰管扩张与 HGD/IC 相关。
结论
EEBGPCN 漏诊 HGD/IC 的比例较低。在 EEBGPCN 中，血清 CA 19-9 升高和新发 DM 被验证为 IPMNs 手术切除的适应证。
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