糖类抗原 19-9 是一种侵袭性恶性肿瘤的术前预测因子，用于诊断管状乳头状黏液性肿瘤。
Carbohydrate Antigen 19-9 Is an Invasive Malignancy Preoperative Prognostic Factor for Intraductal Papillary Mucinous Neoplasms.
机构信息
Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan.
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
出版信息
Eur Surg Res. 2021;62(4):262-270. doi: 10.1159/000517558. Epub 2021 Aug 3.
INTRODUCTION
This study aimed to determine the preoperative clinicophysiological and postoperative clinicopathological predictors of malignancy in patients with intraductal papillary mucinous neoplasm (IPMN).
METHODS
This was a retrospective observational study. We included 121 patients (73 men and 48 women; mean age: 68.7 years) who had undergone pancreatic resection for IPMN between 2007 and 2018. These patients were grouped into invasive carcinoma (IPMN-INV, N = 21) and low/high-grade IPMN (IPMN-LG/HG, N = 100) groups. Univariate and multivariate analyses of clinicophysiological parameters were carried out. These parameters were also compared between the IPMN-INV/HG (N = 53) and IPMN-LG (N = 68) groups. Survival analyses according to macroscopic type and IPMN subtypes were performed.
RESULTS
On univariate analysis, age (p = 0.038), carbohydrate antigen (CA) 19-9 (p < 0.001), IPMN macroscopic type (p = 0.001), IPMN subtype (p < 0.001), pancreatic duct diameter (p < 0.001), and mural nodule (p = 0.042), between IPMN-INV and IPMN-LG/HG were found to be significant prognostic factors of malignancy. CA 19-9 was found to be an independent prognostic factor of IPMN malignancy on multivariate analysis (p = 0.035). The 1-, 3-, and 5-year overall survival (OS) rates of the IPMN-INV and IPMN-LG/HG groups were 94.4/100%, 94.4/100%, and 67.2/100%, respectively. The OS rate in the IPMN-LG/HG group was significantly higher than that in the IPMN-INV group (p < 0.001). On univariate analysis, platelet (p = 0.043), CA 19-9 (p = 0.039), prognostic nutritional index (p = 0.034), platelet/lymphocyte ratio (p = 0.01), IPMN macroscopic type (p < 0.001), IPMN subtype (p < 0.001), pancreatic duct diameter (p = 0.036), and mural nodule (p = 0.032) between IPMN-INV/HG and IPMN-LG were found to be significant prognostic factors of malignancy. On multivariate analysis, CA 19-9 was found to be an independent prognostic factor (p = 0.042) between IPMN-INV/HG and IPMN-LG of malignancy. The 1-, 3-, and 5-year OS rates of the IPMN-INV/HG and IPMN-LG groups were 97.9/100%, 97.9/100%, and 82.6/100%, respectively. The OS rate was significantly higher in the IPMN-LG group than in the IPMN-INV/HG group (p = 0.03). No significant differences in survival were observed in patients with macroscopic tumors (p= 0.544).
CONCLUSION
CA 19-9 is an independent invasive malignancy predictor of IPMN.
简介
本研究旨在确定在患有导管内乳头状黏液性肿瘤（IPMN）的患者中，术前临床生理和术后临床病理预测恶性肿瘤的因素。
方法
这是一项回顾性观察性研究。我们纳入了 2007 年至 2018 年间因 IPMN 接受胰腺切除术的 121 名患者（73 名男性和 48 名女性；平均年龄：68.7 岁）。这些患者被分为浸润性癌（IPMN-INV，N=21）和低/高级别 IPMN（IPMN-LG/HG，N=100）组。对临床生理参数进行单因素和多因素分析。还比较了 IPMN-INV/HG（N=53）和 IPMN-LG（N=68）组之间的这些参数。根据大体类型和 IPMN 亚型进行生存分析。
结果
单因素分析显示，年龄（p=0.038）、碳水化合物抗原（CA）19-9（p<0.001）、IPMN 大体类型（p=0.001）、IPMN 亚型（p<0.001）、胰管直径（p<0.001）和壁结节（p=0.042）在 IPMN-INV 和 IPMN-LG/HG 之间是恶性肿瘤的显著预后因素。多因素分析显示，CA 19-9 是 IPMN 恶性肿瘤的独立预后因素（p=0.035）。IPMN-INV 和 IPMN-LG/HG 组的 1 年、3 年和 5 年总生存率（OS）分别为 94.4/100%、94.4/100%和 67.2/100%。IPMN-LG/HG 组的 OS 率明显高于 IPMN-INV 组（p<0.001）。单因素分析显示，血小板（p=0.043）、CA 19-9（p=0.039）、预后营养指数（p=0.034）、血小板/淋巴细胞比值（p=0.01）、IPMN 大体类型（p<0.001）、IPMN 亚型（p<0.001）、胰管直径（p=0.036）和壁结节（p=0.032）在 IPMN-INV/HG 和 IPMN-LG 之间是恶性肿瘤的显著预后因素。多因素分析显示，CA 19-9 是 IPMN-INV/HG 和 IPMN-LG 恶性肿瘤的独立预后因素（p=0.042）。IPMN-INV/HG 和 IPMN-LG 组的 1 年、3 年和 5 年 OS 率分别为 97.9/100%、97.9/100%和 82.6/100%。IPMN-LG 组的 OS 率明显高于 IPMN-INV/HG 组（p=0.03）。在有大体肿瘤的患者中，生存无显著差异（p=0.544）。
结论
CA 19-9 是 IPMN 浸润性恶性肿瘤的独立预测因子。
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