Mucus is a predictor of better prognosis and survival in patients with intraductal papillary mucinous tumor of the pancreas
Mucus is a predictor of better prognosis and survival in patients with intraductal papillary mucinous tumor of the pancreas
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DOI：
10.1016/s1091-255x(02)00152-x
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发表时间：
2003-01-01
影响因子：
3.2
通讯作者：
Traverso, LW
中科院分区：
文献类型：
--
作者：
Kitagawa, Y;Unger, TA;Traverso, LW
本研究的目的是通过对导管内乳头状黏液性肿瘤（IPMT）患者的病史进行回顾性分析，以确定预后的预测因素。在1989年至2000年期间，对所有因IPMT接受胰腺切除术的患者（n=63）进行了分析。根据手术标本和世界卫生组织的诊断标准进行诊断。采用单变量和多变量分析确定预测因子。病理结果为良性（n=30），原位癌（CIS; n=5）和浸润性癌（n=28）。单因素分析后，恶性肿瘤（浸润性加CIS）的预测因子为黄疸（比值比=10.32）、血清CA 19 -9升高（比值比=15.0）、任何肝功能检查异常（比值比=7.69）和p53过表达。良性疾病的唯一预测因素是内窥镜检查期间观察到的肉眼粘液（比值比=4.35）。多变量分析后，恶性肿瘤的预测因子是任何肝功能检查异常（比值比=5.09）和p53过表达，而良性疾病的唯一预测因子仍然是肉眼粘液（比值比=5.88）。良性疾病的3年和5年生存率分别为95%和83%，恶性疾病分别为52%和44%（P=0.0048）。生存曲线也有利于p53阴性肿瘤与p53阳性肿瘤（P=0.0055）。在33例恶性疾病患者中（平均随访时间=35个月），单变量和多变量分析后，肉眼粘液的存在是生存期延长的预测因素（比值比分别为4.34和4.55），而酗酒是预测因素生存率低（比值比分别为3.41和3.60）。内镜检查期间观察到的大体粘液是良性IPMT的预测因子，在恶性IPMT组中，大体粘液的存在与更好的生存率相关。生存率也与良性IPMT或p53过表达阴性染色密切相关。
The aim of our study was to examine the case histories of patients with intraductal papillary mucinous tumor (IPMT) treated with resection to determine predictors of prognosis. Between 1989 and 2000, all patients treated with pancreatic resection for IPMT (n=63) were analyzed. The diagnosis of IPMT was made using the surgical specimen and the World Health Organization definition. Predictors were determined using univariate and multivariate analysis. The pathologic findings were benign (n=30), carcinoma in situ (CIS; n=5), and invasive carcinoma (n=28). After univariate analysis, predictors of malignancy (invasive plus CIS) were jaundice (odds ratio=10.32), elevated serum CA19-9 (odds ratio=15.0), any abnormal liver function test (odds ratio=7.69), and p53 overexpression. The only predictor of benign disease was gross mucus observed during endoscopy (odds ratio=4.35). After multivariate analysis, predictors of malignancy were any abnormal liver function test (odds ratio=5.09) and p53 overexpression, whereas the only predictor of benign disease was still gross mucus (odds ratio=5.88). Actuarial 3- and 5-year survival for benign disease was 95% and 83% and for malignant disease 52% and 44%, respectively (P=0.0048). Survival curves also favored p53-negative tumors vs. p53-positive tumors (P=0.0055). In the 33 patients with malignant disease (mean follow-up time=35 months), the presence of gross mucus was a predictor of prolonged survival after univariate and multivariate analysis (odds ratio=4.34 and 4.55, respectively), whereas alcohol abuse was a predictor of poor survival (odds ratio=3.41 and 3.60, respectively). Gross mucus observed during endoscopy is a predictor of benign IPMT and, within the group with malignant IPMT; the presence of gross mucus was associated with better survival. Survival was also strongly associated with either benign IPMT or negative staining for p53 overexpression.