中国实用外科杂志

中国实用外科杂志

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单中心360例胰腺导管内乳头状黏液瘤术后病理学特征与预后相关性研究

李    勃1，2，张国虓1，时霄寒1，沈    硕1，高绥之1，潘亚奇1，郭世伟1，金    钢1   

  1. 1 海军军医大学长海医院肝胆胰外科，上海 200433；2 中国人民解放军北戴河康复疗养中心，河北秦皇岛 066100
  • 出版日期:2021-02-01 发布日期:2021-02-05

  • Online:2021-02-01 Published:2021-02-05

摘要： 目的    明确胰腺导管内乳头状黏液瘤（IPMNs）病理学特征与预后的相关性，并结合IPMNs伴浸润癌（INV-IPMNs）病理学特征优化病人的分层。方法    回顾性分析海军军医大学长海医院肝胆胰腺外科2012年1月至2018年12月360例术后病理学诊断为IPMNs的病人的临床资料。采用Kaplan-Meier法分析IPMNs病理学特征与预后的关系 ，Logistic回归分析INV-IPMNs独立相关因素。对TNMⅡ或Ⅲ期、G3、R1、神经侵犯、脉管侵犯、胰胆管型/ 肠型6个病理学指标单独赋值为1，评价病人病理学指标赋值总分预测预后的价值。结果    浸润型癌（P<0.001）和胰胆管型（P=0.019）是IPMNs预后不良的主要危险因素。 病变位于胰体尾较胰头颈钩突进展为INV-IPMNs的风险显著降低（OR=0.41，95%CI 0.23-0.72，P=0.002），多发部位病变较胰头颈钩突进展为INV-IPMNs风险显著增高（OR=7.60，95%CI 1.90-30.35，P=0.004）。肠型（OR=4.83，95%CI 2.71-8.64，P<0.001）、胰胆管型（OR=12.05，95%CI 5.72-25.4，P<0.001）较胃型进展为浸润型癌的风险显著增高。病理学指标赋值总分0-1分、2分和≥3分3层分级可有效预测INV-IPMNs的预后（P=0.002）。结论    INV-IPMNs的3级分层可有效预测预后，有助于指导病人术后精准管理。

关键词: 胰腺导管内乳头状黏液瘤, 预后, 病理

Abstract: Association of pathological characteristics and prognosis in patients with intraductal papillary mucinous neoplasms of the pancreas: A study based on a single institution with 360 patients        LI Bo*, ZHANG Guo-xiao Zhang,SHI Xiao-han Shi, et al.*Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai 200433, China；Beidaihe Rehabilitation and Recuperation Center of PLA, Qinhuangdao 066100, China
Corresponding author: JIN Gang , E-mail: jingang@smmu.edu.cn
LI Bo and  ZHANG Guo-xiao are the first authors who contributed equally to the article
Abstract    Objective    To clarify the association of  pathological characteristics and prognosis in patients with intraductal papillary mucinous neoplasms (IPMNs) and to stratify the invasive IPMNs based on the prognosis. Methods A retrospective analysis of 360 patients, who received surgery and were pathologically identified as IPMNs, was performed. The association of  pathological characteristics and prognosis was analysed by Kaplan-Meier. The independent association factor for invasive IPMNs was done by Logistic regression analysis. TNM stage Ⅱ/Ⅲ，G3，R1，perineural invasion，lymphvascular invasion and pancreatobiliary subtype were aasigned score 1 respectively and the relationship of total score and prognosis was evaluated. Results    Invasive carcinoma (P<0.001) and pancreatobiliary subtype (P=0.019) are the main risk factors for poor prognosis in patients with IPMNs. Compared with tumor located in head，neck and uncinate process of pancreas type, tumor located in body and tail has a lower risk of progression to invasive IPMNs ［OR=0.41, 95% confidential interval (CI) 0.23-0.72, P=0.002］，whereas does multiple tumors of  pancreas have a higher risk of progression to invasive IPMNs (OR=7.60, 95% CI 1.90-30.35, P=0.004). Compared with gastric subtype, intestinal subtype (OR=4.83, 95% CI 2.71-8.64, P<0.001) andpancreatobiliary subtype (OR=12.05, 95% CI 5.72-25.4, P<0.001) has a higher risk of progression to invasive IPMNs. The 3 grade of total score of 0-1，2 and ≥3 can predict the over survival of patients with invasive IPMNs efficiently (P=0.002). Conclusion    The new stratification could successfully predict prognosis of patients with invasive IPMNs and it may faciliate the precise management of invasive IPMNs after surgery.

Key words: intraductal papillary mucinous neoplasms, prognosis, pathology