Hasegawa Hiroyuki, Fukasawa Mitsuharu, Takano Shinichi, Kawakami Satoshi, Kuratomi Natsuhiko, Harai Shota, Yoshimura Dai, Imagawa Naoto, Okuwaki Tetsuya, Kuno Toru, Suzuki Yuichiro, Yoshida Takashi, Kobayashi Shoji, Sato Mitsuaki, Maekawa Shinya, Hosomura Naohiro, Kawaida Hiromichi, Ichikawa Daisuke, Enomoto Nobuyuki
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan.
Department of Gastroenterology, Japan Community Health Care Organization, Yamanashi Hospital, 3-11-16, Asahi, Kofu 400-0025, Yamanashi, Japan.
Diagnostics (Basel). 2024 Nov 17;14(22):2582. doi: 10.3390/diagnostics14222582.
: The present study aimed to validate the new international guidelines for IPMN and determine the surgical criteria for patients with IPMN exhibiting high-risk stigmata (HRS). : We enrolled 115 IPMN patients exhibiting HRS who were diagnosed between 2004 and 2021. Of the 115 patients, 79 underwent surgery (surgical group) and 36 did not undergo surgery (non-surgical group). The overall survival (OS) of each group was compared, and multivariate analysis was performed to identify factors associated with OS. : There was no significant difference in the estimated 5-year OS in the surgical and non-surgical groups (67% vs. 74%; = 0.75). The presence of a solid component (SC) (hazard ratio [HR], 6.92; 95% confidence interval [CI], 3.30-14.5) and a high score of age-adjusted Charlson comorbidity index (ACCI) (≥5) (HR, 2.27; 95% CI, 1.11-4.64) were independent predictors of poor OS. In the presence of an SC, the surgical group had a significantly better OS than the non-surgical group (estimated 5-year OS, 38% vs. 18%; = 0.031). In the absence of an SC, the prognosis of patients with a high ACCI was significantly poorer than those with a low ACCI in the surgical group (estimated 5-year OS, 59% vs. 93%; = 0.005). : An SC and a high ACCI are important prognostic factors in IPMN patients exhibiting HRS. Thus, patients with an SC should undergo surgical resection. However, conservative management may be the optimal treatment in patients without an SC and with a high ACCI.
本研究旨在验证国际胰腺导管内乳头状黏液性肿瘤（IPMN）新指南，并确定具有高危特征（HRS）的IPMN患者的手术标准。我们纳入了2004年至2021年间诊断出的115例具有HRS的IPMN患者。在这115例患者中，79例接受了手术（手术组），36例未接受手术（非手术组）。比较了每组的总生存期（OS），并进行多因素分析以确定与OS相关的因素。手术组和非手术组的估计5年OS无显著差异（67%对74%；P = 0.75）。实性成分（SC）的存在（风险比[HR]，6.92；95%置信区间[CI]，3.30 - 14.5）和年龄调整Charlson合并症指数（ACCI）高分（≥5）（HR，2.27；95% CI，1.11 - 4.64）是OS不良的独立预测因素。存在SC时，手术组的OS明显优于非手术组（估计5年OS，38%对18%；P = 0.031）。不存在SC时，手术组中ACCI高的患者预后明显比ACCI低的患者差（估计5年OS，59%对93%；P = 0.005）。SC和高ACCI是具有HRS的IPMN患者的重要预后因素。因此，有SC的患者应接受手术切除。然而，对于没有SC且ACCI高的患者，保守治疗可能是最佳治疗方法。
