Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas
Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas
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DOI：
10.1136/gut.2010.210567
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发表时间：
2011-04-01
期刊：
影响因子：
24.5
通讯作者：
Shimizu, Michio
中科院分区：
文献类型：
--
作者：
Furukawa, Toru;Hatori, Takashi;Shimizu, Michio
目的探讨胰腺导管内乳头状黏液性肿瘤（intra-ductal papillary mucinous neoplasms of the pancreas，IPMNs）的临床病理学意义，并对283例手术切除的IPMNs进行回顾性多中心分析。这些类型与包括性别在内的临床病理因素显著相关（p=0.0032），年龄（p=0.00924），扩张导管尺寸（p=0.0245），壁结节检测（p=4.09x10（-6）），组织学分级（p < 2.20x10（-16）），胰管系统不同受累的肉眼类型（p=3.91x10（-5））、侵袭表型（p=3.34x10（-12））、分期（p < 2.20x10（-16））和复发（p=0.00574）。Kaplan-Meier分析显示，不同形态学类型的患者生存率存在显著差异（p=5.24x10（-6））。5年和10年的生存率分别为0.937（95% CI 0.892 - 0.984），胃型IPMN患者; 0.886（95% CI 0.813 - 0.965）和0.685（95% CI 0.553至0.849），对于具有尿道型IPMN的患者; 0.839对于嗜酸细胞型IPMN，为0.734（95%CI 0.526至1.000）;对于胰胆型IPMN，为0.520（95%CI 0.298至0.909）和未确定。通过考克斯比例风险模型分析比较了由分期和形态学及肉眼类型确定的预后风险，结果表明分期是最重要的生存预测因素（p= 3.68 × 10（-8）），其次是形态学类型（p=0.0435）。此外，形态类型仍然是一个显着的预测在一个亚队列的侵袭性病例（p=0.0089）。结论在这个多中心的回顾性分析，形态类型的IPMN似乎是一个独立的预测患者的预后。
Objective The clinicopathological significance of four morphological types of intraductal papillary mucinous neoplasms of the pancreas (IPMNs; gastric, intestinal, pancreatobiliary and oncocytic) was assessed.Design Retrospective multicentre analysis of 283 surgically resected IPMNs.Results Of the 283 IPMNs, 139 were of the gastric type, 101 were intestinal, 19 were pancreatobiliary and 24 were oncocytic. These types were significantly associated with clinicopathological factors including sex (p=0.0032), age (p=0.00924), ectatic duct size (p=0.0245), detection of mural nodules (p=4.09x10(-6)), histological grade (p < 2.20x10(-16)), macroscopic types with differential involvement of the pancreatic duct system (p=3.91x10(-5)), invasive phenotypes (p=3.34x10(-12)), stage (p < 2.20x10(-16)) and recurrence (p=0.00574). Kaplan-Meier analysis showed significant differences in patient survival by morphological type (p=5.24x10(-6)). Survival rates at 5 and 10 years, respectively, were 0.937 (95% CI 0.892 to 0.984) for patients with gastric-type IPMNs; 0.886 (95% CI 0.813 to 0.965) and 0.685 (95% CI 0.553 to 0.849) for those with intestinal-type IPMNs; 0.839 (95% CI 0.684 to 1.000) and 0.734 (95% CI 0.526 to 1.000) for those with oncocytic-type IPMNs; and 0.520 (95% CI 0.298 to 0.909) and undetermined for those with pancreatobiliary-type IPMNs. Analysis by the Cox proportional hazards model comparing prognostic risks determined by stage and the morphological and macroscopic types indicated that staging was the most significant predictor of survival (p=3.68x10(-8)) followed by the morphological type (p=0.0435). Furthermore, the morphological type remained a significant predictor in a subcohort of invasive cases (p=0.0089).Conclusion In this multicentre retrospective analysis, the morphological type of IPMN appears to be an independent predictor of patient prognosis.