Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan.
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Eur Surg Res. 2021;62(4):262-270. doi: 10.1159/000517558. Epub 2021 Aug 3.
This study aimed to determine the preoperative clinicophysiological and postoperative clinicopathological predictors of malignancy in patients with intraductal papillary mucinous neoplasm (IPMN).
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.
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).
CA 19-9 is an independent invasive malignancy predictor of IPMN.
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。
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。
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）。
CA 19-9 是 IPMN 浸润性恶性肿瘤的独立预测因子。
