Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
J Transl Med. 2021 Dec 24;19(1):525. doi: 10.1186/s12967-021-03188-4.
The current guidelines of the American Joint Committee on Cancer (AJCC) for the staging of exocrine pancreatic tumors seem inapplicable to malignant pancreatic intraductal papillary mucinous neoplasms (IPMN). Therefore, we aimed to improve the accuracy of clinical staging and prognosis for malignant IPMN by modifiing current AJCC system.
We extracted data of 2001 patients with malignant IPMN from the Surveillance, Epidemiology, and End Results database between 2000 and 2016. Of these, 1401 patients were assigned to the primary cohort and 600 patients to the validation cohort.
In Kaplan-Meier analysis of the primary cohort, the current AJCC guidelines were unable to distinguish between certain tumor substages (IA and IB in the 7th, IB and IIA in the 8th). The modified system that we regrouped based on the median overall survival and hazard ratios, was superior in tumor stage classifications. Age > 70 years, tumors located in the body or tail, high-grade differentiated tumors, surgery, chemotherapy, and tumor, lymph node, and metastasis (TNM) stage were identified as independent predictive factors for overall survival. Compared to that of TNM-based systems, the concordance index of the clinical predictive nomogram significantly improved (0.819; 95% confidence interval, 0.805-0.833), with excellent area under the receiver operating characteristic curves (1-, 3-, and 5-year: 0.881, 0.889, and 0.879, respectively). The calibration curves also showed good agreement between prediction and actual observation. The analysis of treatment modalities revealed that surgery resulted in better survival for all resectable malignant IPMN. The analysis of chemotherapy data reveals its potential in improving the prognosis of treatment for patients with locally advanced or distant metastases.
Our modified staging system improves the distinction of tumor stages. The nomogram was a more accurate and clinically reliable tool for prognosis prediction of patients with malignant IPMN.
美国癌症联合委员会（AJCC）目前用于外分泌胰腺肿瘤分期的指南似乎不适用于恶性胰腺导管内乳头状黏液性肿瘤（IPMN）。因此，我们旨在通过修改当前 AJCC 系统来提高恶性 IPMN 的临床分期和预后的准确性。
我们从 2000 年至 2016 年的监测、流行病学和最终结果数据库中提取了 2001 例恶性 IPMN 患者的数据。其中，1401 例患者被分配到主队列，600 例患者被分配到验证队列。
在主队列的 Kaplan-Meier 分析中，当前 AJCC 指南无法区分某些肿瘤亚期（第 7 版的 IA 和 IB，第 8 版的 IB 和 IIA）。我们根据中位总生存期和风险比重新分组的改良系统在肿瘤分期分类方面更具优势。年龄>70 岁、肿瘤位于体部或尾部、高级别分化肿瘤、手术、化疗和肿瘤、淋巴结和转移（TNM）分期是总生存的独立预测因素。与 TNM 为基础的系统相比，临床预测列线图的一致性指数显著提高（0.819；95%置信区间，0.805-0.833），具有极好的接收者操作特征曲线下面积（1 年、3 年和 5 年分别为 0.881、0.889 和 0.879）。校准曲线也显示了预测与实际观察之间的良好一致性。治疗方式分析表明，手术可使所有可切除的恶性 IPMN 患者获得更好的生存。对化疗数据的分析揭示了其在改善局部晚期或远处转移患者治疗预后方面的潜力。
我们改良的分期系统提高了肿瘤分期的区分度。列线图是一种更准确、更具临床可靠性的工具，可用于预测恶性 IPMN 患者的预后。
Zotero 插件
