Huang Xiaoyi, You Siting, Ding Guiling, Liu Xingchen, Wang Jin, Gao Yisha, Zheng Jianming
Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Central Laboratory, Changhai Hospital, Second Military Medical University, Shanghai, China.
Front Oncol. 2021 Jun 3;11:681961. doi: 10.3389/fonc.2021.681961. eCollection 2021.
To explore the impact of distant metastases on cancer-specific survival in patients with intraductal papillary mucinous neoplasm (IPMN) with associated invasive carcinoma and identify the risk factor of distant metastases in IPMN with associated invasive carcinoma.
Patients with IPMN with associated invasive carcinoma between 2010 and 2015 were retrospectively selected from the Surveillance, Epidemiology, and End Results (SEER) database. The survival analyses were assessed by Kaplan-Meier analyses and log-rank test. The impact of distant metastases was evaluated by Cox regression model and the risk factors of distant metastases were identified by logistic regression analyses, respectively.
The median cancer-specific survival time of patients with no metastases, isolated liver, isolated lung, and multiple site metastases were 19 months, 4 months, 7 months, and 3 months, respectively. In patients with isolated liver metastases, multivariate analysis after adjustment indicated that chemotherapy (Hazard Ratio [HR]=0.351, 95% confidence interval [CI]=0.256-0.481, P<0.001) was a protective prognostic factor for cancer-specific survival (CSS) in patients with isolated liver metastases. In isolated lung metastases subgroup, old age (HR=1.715, 95% CI=1.037-2.838, P=0.036) and chemotherapy (HR=0.242, 95% CI=0.134-0.435, P<0.001) were related to CSS in multivariable Cox regression analysis(P<0.05). Tumor located in the pancreatic body/tail (HR=2.239, 95% CI=1.140-4.400, P=0.019) and chemotherapy (HR=0.191, 95% CI=0.108-0.340, P<0.001) were independent prognostic factors for CSS in patients with multiple metastases. Finally, a nomogram was constructed for cancer-specific survival and the predicted C-index was 0.780 (95% CI=0.762-0.798).
The liver is the most common site of distant metastases in IPMN with associated invasive carcinoma. Tumor located in the pancreatic body/tail and chemotherapy are independent prognostic factors for CSS in patients with multiple metastases. Further, tumor located in body/tail is identified as a risk factor of distant metastases.
探讨远处转移对伴有浸润性癌的导管内乳头状黏液性肿瘤（IPMN）患者癌症特异性生存的影响，并确定伴有浸润性癌的IPMN远处转移的危险因素。
回顾性选取2010年至2015年间监测、流行病学和最终结果（SEER）数据库中伴有浸润性癌的IPMN患者。生存分析采用Kaplan-Meier分析和对数秩检验。分别通过Cox回归模型评估远处转移的影响，并通过逻辑回归分析确定远处转移的危险因素。
无转移、孤立肝转移、孤立肺转移和多部位转移患者的癌症特异性生存时间中位数分别为19个月、4个月、7个月和3个月。在孤立肝转移患者中，调整后的多因素分析表明，化疗（风险比[HR]=0.351，95%置信区间[CI]=0.256-0.481，P<0.001）是孤立肝转移患者癌症特异性生存（CSS）的保护性预后因素。在孤立肺转移亚组中，多变量Cox回归分析显示，高龄（HR=1.715，95%CI=1.037-2.838，P=0.036）和化疗（HR=0.242，95%CI=0.134-0.435，P<0.001）与CSS相关（P<0.05）。肿瘤位于胰体/胰尾（HR=2.239，95%CI=1.140-4.400，P=0.019）和化疗（HR=0.191，95%CI=0.108-0.340，P<0.001）是多部位转移患者CSS的独立预后因素。最后，构建了癌症特异性生存列线图，预测的C指数为0.780（95%CI=0.762-0.798）。
肝脏是伴有浸润性癌的IPMN最常见的远处转移部位。肿瘤位于胰体/胰尾和化疗是多部位转移患者CSS的独立预后因素。此外，肿瘤位于胰体/胰尾被确定为远处转移的危险因素。
