Prediction of invasive carcinoma in branch type intraductal papillary mucinous neoplasms of the pancreas
Prediction of invasive carcinoma in branch type intraductal papillary mucinous neoplasms of the pancreas
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DOI：
10.1007/s00535-010-0238-0
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发表时间：
2010-09-01
影响因子：
6.3
通讯作者：
Shimosegawa, Tooru
中科院分区：
文献类型：
--
作者：
Kanno, Atsushi;Satoh, Kennichi;Shimosegawa, Tooru
背景支管型导管内乳头状粘液瘤（BD-IPMN）无侵袭性，预后良好。然而，当IPMN病变产生浸润性癌细胞时，预后就变得很差。此外，最近的研究显示BD-IPMN常并发普通型胰管癌。因此，BD-IPMN的预后取决于这两种浸润性癌的发生情况。然而，对于BD-IPMN中这些浸润性癌发展的危险因素知之甚少。本研究旨在确定BD-IPMN中浸润性癌发展的预测因素。方法将合并BD-IPMN的浸润性胰腺癌分为浸润性IPMN组（直接来源于IPMN病变的浸润性癌）和伴发性IPMN组（伴发BD-IPMN的常见类型浸润性癌）。回顾性分析BD-IPMN中各类型浸润性癌的发生率与临床病理参数的关系。结果159例BD-IPMN中浸润性IPMN 12例，伴癌7例。单因素分析显示，扩张支直径（P < 0.001）或主胰管直径（P = 0.001）、壁结节大小（P < 0.001）、血清CEA水平（P < 0.001）和血清CA19-9水平（P < 0.001）是侵袭性IPMN的显著相关因素。在这些因素中，壁结节大小大于6.5 mm[优势比14.86 (95% CI 1.37-60.45)；P = 0.02]，血清癌胚抗原（CEA）水平大于5 ng/ml[优势比6.91 (95% CI 1.17-54.13)；P = 0.03]是侵袭性IPMN的独立相关因素。另一方面，单因素和多因素分析显示，碳水化合物抗原19-9 （CA 19-9）水平升高与BD-IPMN伴发导管癌相关[优势比10.31 (95% CI 1.77-81.51)；P = 0.01]。结论BD-IPMN中两种浸润性癌的发展情况，除肿瘤病变外，还需要仔细的全胰腺影像学检查和血清CEA、CA19-9的测定。
Background Patients with branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) without invasion usually show favorable prognosis. However, the prognosis becomes poor when the IPMN lesions give rise to invasive carcinoma cells. In addition, recent studies have revealed that BD-IPMN is frequently complicated by common type pancreatic ductal carcinoma. Thus, the prognosis of BD-IPMN depends on the occurrence of these two types of invasive carcinoma. However, little is known about the risk factors for the development of these invasive carcinomas in BD-IPMN. This study aims to identify the factors which predict the development of invasive carcinoma in BD-IPMN.Methods Invasive pancreatic carcinoma associating with BD-IPMN was classified as invasive IPMN group (invasive carcinoma derived directly from IPMN lesions) and concomitant group (common type of invasive carcinoma concomitant with BD-IPMN). The relation between the incidence of each type of invasive carcinoma in BD-IPMN and the clinicopathological parameters was retrospectively analyzed.Results There were 12 patients with invasive IPMN and 7 patients with concomitant cancer in 159 patients with BD-IPMN. Diameter of dilated branch (P < 0.001) or main pancreatic duct (MPD) (P = 0.001), size of mural nodule (P < 0.001), serum CEA level (P < 0.001) and serum CA19-9 level (P < 0.001) were factors associated significantly with invasive IPMN by univariate analysis. Among these factors, mural nodule with size larger than 6.5 mm [odds ratio 14.86 (95% CI 1.37-60.45); P = 0.02] and serum carcinoembryonic antigen (CEA) level over 5 ng/ml [odds ratio 6.91 (95% CI 1.17-54.13); P = 0.03] were found to be the factors independently associated with invasive IPMN. On the other hand, both univariate and multivariate analyses revealed that elevated carbohydrate antigen 19-9 (CA 19-9) levels were associated with the occurrence of concomitant ductal carcinoma in BD-IPMN [odds ratio 10.31 (95% CI 1.77-81.51); P = 0.01].Conclusions Our results suggested that careful imaging study of the entire pancreas in addition to tumor lesions and measurement of serum CEA and CA19-9 would be required to find out the development of the two types of invasive carcinoma in BD-IPMN.