Development and Validation of a Multi-institutional Preoperative Nomogram for Predicting Grade of Dysplasia in Intraductal Papillary Mucinous Neoplasms (IPMNs) of the Pancreas: A Report from The Pancreatic Surgery Consortium.
Development and Validation of a Multi-institutional Preoperative Nomogram for Predicting Grade of Dysplasia in Intraductal Papillary Mucinous Neoplasms (IPMNs) of the Pancreas: A Report from The Pancreatic Surgery Consortium.
复制标题
胰腺内导管内乳头状粘液性肿瘤（IPMN）的多个机构术前戒指的开发和验证：胰腺外科联盟的报告。
DOI：
10.1097/sla.0000000000002015
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发表时间：
2018-01
影响因子：
9
通讯作者：
Allen PJ
中科院分区：
文献类型：
--
作者：
Attiyeh MA;Fernández-Del Castillo C;Al Efishat M;Eaton AA;Gönen M;Batts R;Pergolini I;Rezaee N;Lillemoe KD;Ferrone CR;Mino-Kenudson M;Weiss MJ;Cameron JL;Hruban RH;D'Angelica MI;DeMatteo RP;Kingham TP;Jarnagin WR;Wolfgang CL;Allen PJ
以往用于导管内乳头状黏液性肿瘤(IPMN)切除患者的诺模图模型都是相对较小的单机构系列模型。我们的目标是通过开发和独立验证使用大型多机构数据集的新模型来改进这些研究。IPMN是胰腺癌最常见的放射学可识别的前驱病变。它们是一组异质性肿瘤，其中更准确的高度不典型增生或早期浸润性癌的标记物可以帮助避免在一个病例中进行不必要的手术，并在另一个病例中支持潜在的根治性干预(切除)。查询来自三个机构的前瞻性维护的数据库，以了解2005至2015年间接受IPMN切除的患者。根据术前影像将患者分为主管型、混合型(MD)和支管型(BD)。在训练子集上使用Logistic回归模型来建立两个独立的诺模图(MD和BD)来预测低危(低或中度不典型增生)或高危(高级别不典型增生或浸润性癌)疾病。然后使用独立的验证集来评估模型的性能。在十年的研究期间，我们确定了1,028名接受IPMN切除的患者[MD：N=454(44%)，BD：N=574(56%)]。487名患者(47%)存在高危疾病。高危疾病患者分别占MD和BD组的71%和29%(p<；0.0001)。在训练集[70%(n=720)；MD：318，BD：n=402]上绘制MD和BD诺模图，并在测试集[30%(n=308)；MD：n=136，BD：n=172]上验证。黄疸的存在几乎完全与高危疾病有关(58名患者中有57名，98%)。囊腔大小3.0厘米、实性成分/壁结节、疼痛症状和体重减轻与高危疾病显著相关。C指数在训练集和独立验证集上分别为0.82和0.81；Brier得分分别为0.173和0.175。对于可疑的IPMN患者，我们提出了一个独立验证的预测高危疾病的模型。
Previous nomogram models for patients undergoing resection of intraductal papillary mucinous neoplasms (IPMNs) have been relatively small single-institutional series. Our objective was to improve upon these studies by developing and independently validating a new model using a large multi-institutional dataset. IPMNs represent the most common radiographically identifiable precursor lesions of pancreatic cancer. They are a heterogenous group of neoplasms in which more accurate markers of high-grade dysplasia or early invasive carcinoma could help avoid unnecessary surgery in one case and support potentially curative intervention (resection) in another. Prospectively maintained databases from three institutions were queried for patients who had undergone resection of IPMNs between 2005 and 2015. Patients were separated into main duct [main and mixed-type (MD)] and branch duct (BD) types based on preoperative imaging. Logistic regression modeling was used on a training subset to develop two independent nomograms (MD and BD) to predict low-risk (low- or intermediate-grade dysplasia) or high-risk (high-grade dysplasia or invasive carcinoma) disease. Model performance was then evaluated using an independent validation set. We identified 1,028 patients who underwent resection for IPMNs [MD: n = 454 (44%), BD: n = 574 (56%)] during the ten-year study period. High-risk disease was present in 487 patients (47%). Patients with high-risk disease comprised 71% and 29% of MD and BD groups, respectively (p < 0.0001). MD and BD nomograms were developed on the training set [70% of total (n = 720); MD: n = 318, BD: n = 402] and validated on the test set [30% (n = 308); MD: n = 136, BD: n = 172]. The presence of jaundice was almost exclusively associated with high-risk disease (57 of 58 patients, 98%). Cyst size > 3.0 cm, solid component/mural nodule, pain symptoms, and weight loss were significantly associated with high-risk disease. C-indices were 0.82 and 0.81 on training and independent validation sets, respectively; Brier scores were 0.173 and 0.175, respectively. For patients with suspected IPMNs, we present an independently validated model for the prediction of high-risk disease.