胰腺导管腺癌和浸润性导管内乳头状黏液性肿瘤：不同的总生存预后因素。

Pancreatic ductal adenocarcinoma and invasive intraductal papillary mucinous tumor: Different prognostic factors for different overall survival.

机构信息

Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy.

Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Humanitas University Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.

出版信息

Dig Liver Dis. 2022 Jun;54(6):826-833. doi: 10.1016/j.dld.2021.06.006. Epub 2021 Jul 1.

DOI:10.1016/j.dld.2021.06.006

PMID:34219044

Abstract

BACKGROUND

It is unclear whether invasive intraductal papillary mucinous neoplasm (IPMN) has different clinical and prognostic characteristics, beyond histological factors, when compared to pancreatic ductal adenocarcinoma (PDAC).

AIMS

compare prognostic features of resected PDAC and invasive IPMN METHODS: A retrospective study of patients resected for PDAC or invasive IPMN realized at Humanitas Cancer Center's Pancreatic Surgery Unit, Milan, Italy, between 2010 and 2016. Data recorded included patient demographics, onset symptoms, preoperative health status, tumor features, histology and surgical characteristics. Overall survival was estimated using Kaplan-Meier and prognostic factors for survival were assessed by multivariate Cox regression.

RESULTS

A total of 332 patients were included (PDAC, n = 289; invasive IPMN, n = 43). Patients with invasive IPMN had better overall survival than PDAC patients (median: 76.6 versus 25.6 months; 5-year OS rate: 65.4% vs. 14.2%; p < 0.001). PDAC histology was associated with a significantly higher risk of death than IPMN (hazard ratio 1.815, 95% CI: 1.02, 3.24; p = 0.044). Survival was also worse with PDAC in early-stage disease (IA-IB-IIA, N0). In multivariate analysis, independent predictors of worse survival included perineural invasion, preoperative ASA physical status ≥3 and pain at diagnosis.

CONCLUSIONS

Patients with IPMN had a better prognosis than PDAC patients, regardless of disease stage.

摘要

背景

与胰腺导管腺癌（PDAC）相比，浸润性导管内乳头状黏液性肿瘤（IPMN）除了组织学因素外，其临床和预后特征是否不同尚不清楚。

目的

比较经手术切除的 PDAC 和浸润性 IPMN 的预后特征。

方法

这是一项回顾性研究，纳入了 2010 年至 2016 年在意大利米兰 Humanitas 癌症中心胰腺外科单元接受手术治疗的 PDAC 或浸润性 IPMN 患者。记录的数据包括患者的人口统计学特征、首发症状、术前健康状况、肿瘤特征、组织学和手术特征。采用 Kaplan-Meier 法估计总生存率，并采用多变量 Cox 回归分析生存的预后因素。

结果

共纳入 332 例患者（PDAC 患者 289 例，浸润性 IPMN 患者 43 例）。浸润性 IPMN 患者的总生存率明显优于 PDAC 患者（中位：76.6 与 25.6 个月；5 年 OS 率：65.4%与 14.2%；p<0.001）。与 IPMN 相比，PDAC 组织学与死亡风险显著升高相关（风险比 1.815，95%CI：1.02，3.24；p=0.044）。早期疾病（IA-IB-IIA，N0）的 PDAC 患者生存情况更差。多变量分析显示，预后不良的独立预测因素包括神经周围侵犯、术前美国麻醉医师协会（ASA）身体状况≥3 级和诊断时疼痛。