Department of Gastroenterology and Alimentary Tract Surgery, Tampere University, Finland; Faculty of Medicine and Health Technology, Tampere University, Finland.
Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Finland.
Surgery. 2023 Jul;174(1):75-82. doi: 10.1016/j.surg.2023.02.006. Epub 2023 Apr 15.
The degree of dysplasia is the most important prognostic factor for patients with resected intraductal papillary mucinous neoplasms. Intraductal papillary mucinous neoplasms are predominantly premalignant conditions; in most cases, surveillance is an adequate treatment. If worrisome features are present, surgery should be considered. However, there is limited data on the long-term prognosis of resected intraductal papillary mucinous neoplasms. We aimed to ascertain the nationwide survival of patients with resected intraductal papillary mucinous neoplasms and identify factors associated with survival.
This is a retrospective nationwide cohort study. All intraductal papillary mucinous neoplasms operated on in Finland between 2000 and 2008 were identified. Patient records were evaluated, and original radiologic data and histologic samples were re-evaluated. Survival data were collected after a 10-year follow-up period.
Out of 2,024 pancreatic resections, 88 were performed for intraductal papillary mucinous neoplasm. The median age of the patients was 65 years. Histologic diagnoses were main duct intraductal papillary mucinous neoplasm 47/88 (53,4%), mixed-type intraductal papillary mucinous neoplasm 27/88 (30.7%), and branchduct intraductal papillary mucinous neoplasm 14/88 (15.9%). Of the tumors, 40/88 (45.5%) were low-grade dysplasia, 9/88 (10.2%) high-grade, and 39/88 (44.3%) were invasive cancer. The median survival was 121 (range 0-252) months. Ten-year survival was 72.5%, 66.7%, and 23.1% in the low-grade dysplasia, high-grade dysplasia, invasive cancer groups, respectively. Ten-year mortality for pancreatic cancer was 5%, 9.1%, and 71.8% in the low-grade dysplasia, high-grade dysplasia, invasive cancer groups, respectively.
Overall, 44.3% of the patients had a malignant tumor, and three-quarters (74.5%) of the main duct intraductal papillary mucinous neoplasms were malignant or high-grade dysplasia at the time of surgery. Ten-year survival was significantly better in patients operated on at the stage of a premalignant tumor (low-grade dysplasia + high-grade dysplasia) than in patients operated on at the stage of a malignant tumor.
对于接受切除治疗的胰腺导管内乳头状黏液性肿瘤（IPMN）患者，肿瘤异型增生程度是最重要的预后因素。IPMN 主要为癌前病变，多数情况下监测即可，仅当存在可疑特征时才考虑手术治疗。然而，目前关于接受切除治疗的 IPMN 患者的长期预后数据有限。本研究旨在明确接受胰腺切除治疗的 IPMN 患者的全国性生存率，并确定与生存率相关的因素。
这是一项回顾性全国性队列研究。纳入 2000 年至 2008 年期间在芬兰接受胰腺切除治疗的所有 IPMN 患者。评估患者的病历，重新评估原始影像学数据和组织学样本。在 10 年随访后收集生存数据。
在 2024 例胰腺切除术中，有 88 例为 IPMN 切除术。患者的中位年龄为 65 岁。组织学诊断为主胰管 IPMN（47/88，53.4%）、混合型 IPMN（27/88，30.7%）和分支胰管 IPMN（14/88，15.9%）。其中，40 例（45.5%）肿瘤为低级别异型增生，9 例（10.2%）为高级别异型增生，39 例（44.3%）为浸润性癌。中位生存时间为 121（0-252）个月。低级别异型增生、高级别异型增生和浸润性癌组的 10 年生存率分别为 72.5%、66.7%和 23.1%。低级别异型增生、高级别异型增生和浸润性癌组的胰腺癌 10 年死亡率分别为 5%、9.1%和 71.8%。
总体而言，44.3%的患者为恶性肿瘤，其中 75%（74.5%）的主胰管 IPMN 在手术时为恶性或高级别异型增生。在处于癌前病变（低级别异型增生+高级别异型增生）阶段接受手术治疗的患者中，10 年生存率显著优于在恶性肿瘤阶段接受手术治疗的患者。
