单中心360例胰腺导管内乳头状黏液瘤术后病理学特征与预后相关性研究

Association of pathological characteristics and prognosis in patients with intraductal papillary mucinous neoplasms of the pancreas: A study based on a single institution with 360 patients

目的明确胰腺导管内乳头状黏液瘤(IPMNs)病理学特征与预后的相关性,并结合IPMNs伴浸润癌(INV-IPMNs)病理学特征优化病人的分层。方法回顾性分析海军军医大学长海医院肝胆胰腺外科2012年1月至2018年12月360例术后病理学诊断为IPMNs的病人的临床资料。采用Kaplan-Meier法分析IPMNs病理学特征与预后的关系,Logistic回归分析INV-IPMNs独立相关因素。对TNMⅡ或Ⅲ期、G3、R1、神经侵犯、脉管侵犯、胰胆管型/肠型6个病理学指标单独赋值为1,评价病人病理学指标赋值总分预测预后的价值。结果浸润型癌(P<0.001)和胰胆管型(P=0.019)是IPMNs预后不良的主要危险因素。病变位于胰体尾较胰头颈钩突进展为INV-IPMNs的风险显著降低(OR=0.41,95%CI 0.23-0.72,P=0.002),多发部位病变较胰头颈钩突进展为INVIPMNs风险显著增高(OR=7.60,95%CI 1.90-30.35,P=0.004)。肠型(OR=4.83,95%CI 2.71-8.64,P<0.001)、胰胆管型(OR=12.05,95%CI 5.72-25.4,P<0.001)较胃型进展为浸润型癌的风险显著增高。病理学指标赋值总分0-1分、2分和≥3分3层分级可有效预测INV-IPMNs的预后(P=0.002)。结论INV-IPMNs的3级分层可有效预测预后,有助于指导病人术后精准管理。

ObjectiveTo clarify the association of pathological characteristics and prognosis in patients withintraductal papillary mucinous neoplasms(IPMNs)and to stratify the invasive IPMNs based on the prognosis.Methods A retrospective analysis of 360 patients,who received surgery and were pathologically identified as IPMNs,wasperformed.The association of pathological characteristics and prognosis was analysed by Kaplan-Meier.Theindependent association factor for invasive IPMNs was done by Logistic regression analysis.TNM stageⅡ/Ⅲ,G3,R1,perineural invasion,lymphvascular invasion and pancreatobiliary subtype were aasigned score 1 respectively and therelationship of total score and prognosis was evaluated.ResultsInvasive carcinoma(P<0.001)and pancreatobiliarysubtype(P=0.019)are the main risk factors for poor prognosis in patients with IPMNs.Compared with tumor located inhead,neck and uncinate process of pancreas type,tumor located in body and tail has a lower risk of progression toinvasive IPMNs[OR=0.41,95%confidential interval(CI)0.23-0.72,P=0.002],whereas does multiple tumors ofpancreas have a higher risk of progression to invasive IPMNs(OR=7.60,95%CI 1.90-30.35,P=0.004).Compared withgastric subtype,intestinal subtype(OR=4.83,95%CI 2.71-8.64,P<0.001)andpancreatobiliary subtype(OR=12.05,95%CI 5.72-25.4,P<0.001)has a higher risk of progression to invasive IPMNs.The 3 grade of total score of 0-1,2 and≥3 can predict the over survival of patients with invasive IPMNs efficiently(P=0.002).ConclusionThe newstratification could successfully predict prognosisof patients with invasive IPMNs and it may faciliatethe precise management of invasive IPMNs aftersurgery.