A prediction rule for estimating pancreatic cancer risk in chronic pancreatitis patients with focal pancreatic mass lesions with prior negative EUS-FNA cytology
A prediction rule for estimating pancreatic cancer risk in chronic pancreatitis patients with focal pancreatic mass lesions with prior negative EUS-FNA cytology
复制标题
评估先前 EUS-FNA 细胞学阴性的局灶性胰腺肿块病变的慢性胰腺炎患者胰腺癌风险的预测规则
DOI：
10.3109/00365521.2010.539256
复制
发表时间：
2011-04-01
影响因子：
1.9
通讯作者：
Li, Zhao-Shen
中科院分区：
文献类型：
--
作者：
Cai, Quan-Cai;Chen, Yan;Li, Zhao-Shen
抽象目标。慢性胰腺炎患者胰腺局灶性肿块的超声内镜引导下细针穿刺活检（EUS-FNA）结果存在相当多的假阴性。我们的目的是建立一个预测规则，对有胰腺局灶性病变且既往EUS-FNA细胞学检查阴性的慢性胰腺炎患者的胰腺癌风险进行分层。材料和方法。2000年1月至2008年5月期间，从三家医院共确定了138名合格的连续患者。胰腺肿块病变的最终诊断经组织学证实或通过至少12个月的随访证实。通过使用基于回归系数的评分方法从逻辑回归模型开发预测规则，然后通过使用自举进行内部验证。结果队列中胰腺癌的发生率为18.1%。预测规则评分为0 - 10分，包括5个变量：性别、肿块位置、肿块数量、直接胆红素和CA 19-9。在87.7%的低风险评分（≤3）患者中，胰腺癌风险为13.2%;相比之下，在12.3%的高风险评分（>3）患者中，胰腺癌风险为52.9%（p < 0.001）。如果对高风险患者进行进一步的侵入性检查，36%的胰腺癌患者不会被遗漏。预测规则具有良好的区分度（受试者工作特征曲线下的面积，0.72）和校准（p = 0.96）。结论.该预测规则可为既往EUS-FNA细胞学阴性的局灶性肿块病变慢性胰腺炎患者提供胰腺癌的危险分层。危险分层的应用可以改善临床决策。
Abstract Objective. Considerable false-negative endoscopic ultrasound guided fine needle aspiration (EUS-FNA) findings exist in chronic pancreatitis patients with focal pancreatic mass lesions. Our aim was to develop a prediction rule to stratify risk for pancreatic cancer in chronic pancreatitis patients with focal pancreatic mass lesions with prior negative EUS-FNA cytology. Material and methods. A total of 138 eligible consecutive patients were identified from three hospitals between January 2000 and May 2008. A final diagnosis of pancreatic mass lesions was confirmed histologically or verified by a follow-up of at least 12 months. A prediction rule was developed from a logistic regression model by using a regression coefficient-based scoring method, and then internally validated by using bootstrapping. Results. The rate of pancreatic cancer in the cohort was 18.1%. The prediction rule, which was scored from 0 to 10 points, comprised five variables: sex, mass location, mass number, direct bilirubin, and CA 19-9. Among the 87.7% of patients with low-risk scores (≤3), the risk of pancreatic cancer was 13.2%; by comparison, this risk was 52.9% (p < 0.001) among the 12.3% of patients with high-risk scores (>3). If further invasive tests were used for patients with high risk, 36% of patients with pancreatic cancer would not be missed. The prediction rule had good discrimination (area under the receiver operating characteristic curve, 0.72) and calibration (p = 0.96). Conclusions. The prediction rule can provide available risk stratification for pancreatic cancer in chronic pancreatitis patients with focal mass lesions with prior negative EUS-FNA cytology. Application of risk stratification may improve clinical decision making.