Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea.
J Hepatobiliary Pancreat Sci. 2022 Sep;29(9):1014-1024. doi: 10.1002/jhbp.1161. Epub 2022 May 9.
BACKGROUND/PURPOSE: Surgical indications of main duct-involved intraductal papillary mucinous neoplasm (IPMN), especially for main pancreatic duct (MPD) of 5-9 mm, remain controversial. We aimed to predict malignancy risk of main duct-involved IPMN.
Total 258 patients with main duct-involved IPMN between 2000 and 2017 in our institute were retrospectively analyzed. Main duct IPMN was classified into segmental and diffuse-type by dilated MPD pattern. Clinicopathologic features and predictive factors for malignancy were analyzed.
Among 258 patients, 47 and 211 had pure main duct (segmental: 27, diffuse type: 20) and mixed type, respectively. Malignant IPMN presented higher in main duct type (66.0%) compared to mixed type (46.9%). The diffuse type (72.2%) had more invasive carcinoma than the segmental type (40.7%). Invasive IPMN risk increased proportionally to the MPD diameter (5 ≤ MPD <10 mm vs 10 ≤ MPD < 15 mm vs MPD ≥ 15 mm; 23.4% vs 40.0% vs 48.6%). Symptoms, elevated serum carbohydrate antigen, MPD ≥10 mm, mural nodule, thickened wall, and distal atrophy were independent predictive factors for malignancy. Patients with MPD of 5-9 mm with at least one predictive factor had 35.0% of malignancy risk.
The invasive IPMN risk was different according to the dilated main duct pattern. Patients with main duct type, diffuse type, MPD ≥10 mm, and MPD 5-9 mm with at least one predictive factor should be candidates for immediate surgery.
背景/目的：主胰管受累型胰管内乳头状黏液性肿瘤（IPMN）的手术指征，尤其是主胰管（MPD）为 5-9mm 的手术指征，仍存在争议。本研究旨在预测主胰管受累型 IPMN 的恶性风险。
回顾性分析了 2000 年至 2017 年我院 258 例主胰管受累型 IPMN 患者的临床病理资料。根据扩张的 MPD 模式，将主胰管 IPMN 分为节段性和弥漫性。分析了临床病理特征和恶性肿瘤的预测因素。
258 例患者中，单纯主胰管（节段性：27 例，弥漫性：20 例）和混合性分别为 47 例和 211 例。主胰管型恶性 IPMN 发生率（66.0%）高于混合性（46.9%）。弥漫性（72.2%）比节段性（40.7%）更易发生浸润性癌。浸润性 IPMN 风险随 MPD 直径的增加而增加（5≤MPD<10mm 与 10≤MPD<15mm 与 MPD≥15mm；23.4%与 40.0%与 48.6%）。症状、血清糖链抗原升高、MPD≥10mm、壁内结节、管壁增厚和远端萎缩是恶性的独立预测因素。MPD 为 5-9mm 且至少有一个预测因素的患者，恶性风险为 35.0%。
根据扩张的主胰管模式，侵袭性 IPMN 的风险不同。主胰管型、弥漫型、MPD≥10mm 和 MPD 为 5-9mm 且至少有一个预测因素的患者应作为立即手术的候选者。
