Zhang Honghui, Zhong Zhendong, Kong Gaoyin, Khan Junaid, Zou Lianhong, Jiang Yu, Liu Xiehong, Tang Yixun, Jiang Bo, Peng Chuang, Song Yinghui, Liu Sulai
Department of Hepatobiliary Surgery/Hunan Research Center of Biliary Disease, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan province, China.
Biliary Disease Research Laboratory of Hunan Provincial People's Hospital, Key Laboratory of Hunan Normal University, Changsha, Hunan province, China.
PeerJ. 2020 Sep 30;8:e10040. doi: 10.7717/peerj.10040. eCollection 2020.
Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is considered an uncommon tumor, and there is limited understanding of IPMN-B. This study aimed to investigate the prognosis and influential factors of the IPMN-B from 58 cases.
The clinical data of 58 patients with pathologically confirmed IPMN-B admitted to our hospital from January 1, 2012 to August 2017 were collected and analyzed. The patients were followed up by outpatient or telephone until January 1, 2019. SPSS 19.0 software was applied for data analysis. Survival analysis was performed using Kaplan-Meier method and parallel Log-rank test. Prognostic factors were analyzed by univariate analysis and multiple Cox regression model.
Among of all the patients, 26 cases were benign tumors and 32 cases were malignant tumors. The preoperative tumor markers CA242 and CEA of malignant IPNM-B patients were significantly higher than those in benign tumors ( < 0.05). Survival analysis showed that patients with malignant tumors had a worse prognosis. The median survival time of malignant IPMN-B patients was 40.6 ± 3.0 months, yet median survival time of benign IPMN-B patients was not reached ( = 0.19). The one-year survival rate and three-year survival rate of benign IPMN-B were 84% and 74% respectively. The one-year survival rate and three-year survival rate of malignant IPMN-B were 88% and 64% respectively. Univariate analysis showed that combined lymph node metastasis, surgical method, and differentiation degree could affect patients' prognosis ( < 0.05). Multivariate analysis showed differentiation degree was an independent risk factor affecting prognosis (OR = 0.06, 95% confidence interval: 0.007∼0.486, < 0.05).
The levels of CEA and CA242 were helpful to identify benign and malignant of IPNM-B. Moreover, radical surgical resection could prolong patients' survival. Finally, differentiation degree was an independent risk factor affecting malignant IPNM-B prognosis.
胆管内乳头状黏液性肿瘤（IPMN-B）被认为是一种罕见肿瘤，人们对其了解有限。本研究旨在探讨58例IPMN-B患者的预后及影响因素。
收集2012年1月1日至2017年8月我院收治的58例经病理确诊的IPMN-B患者的临床资料并进行分析。通过门诊或电话对患者进行随访至2019年1月1日。应用SPSS 19.0软件进行数据分析。采用Kaplan-Meier法和并行对数秩检验进行生存分析。通过单因素分析和多因素Cox回归模型分析预后因素。
所有患者中，26例为良性肿瘤，32例为恶性肿瘤。恶性IPNM-B患者术前肿瘤标志物CA242和CEA显著高于良性肿瘤患者（P<0.05）。生存分析显示，恶性肿瘤患者预后较差。恶性IPMN-B患者的中位生存时间为40.6±3.0个月，而良性IPMN-B患者的中位生存时间未达到（P=0.19）。良性IPMN-B的1年生存率和3年生存率分别为84%和74%。恶性IPMN-B的1年生存率和3年生存率分别为88%和64%。单因素分析显示，合并淋巴结转移、手术方式和分化程度可影响患者预后（P<0.05）。多因素分析显示，分化程度是影响预后的独立危险因素（OR=0.06，95%置信区间：0.007～0.486，P<0.05）。
CEA和CA242水平有助于鉴别IPNM-B的良恶性。此外，根治性手术切除可延长患者生存期。最后，分化程度是影响恶性IPNM-B预后的独立危险因素。
