胰腺导管内乳头状黏液性肿瘤形态学特征与疾病良恶性的相关分析

Correlative characteristics of morphological features of benign/malignancy in pancreatic intraductal papil- lary mucinous neoplasms., a pooled analysis

目的寻找与胰腺导管内乳头状黏液性肿瘤（IPMN）良恶性相关的形态学特征以供临床实践参考。方法研究尝试运用汇集分析的方法，通过对PubMed数据库中2011年6月30日以前所发表文献中经病理学证实的胰腺IPMN的形态学特征进行分析。主要分析数据为：性别特征、主胰管直径、囊性病变直径、壁结节情况、肿瘤的病理学类型（良、恶性）。结果共汇集文献98篇，胰腺IPMN病例1902例，其中良性1025例（53．89％），恶性877例（46．11％）。胰腺IPMN形态学特征中，主胰管扩张（≥5mm）、囊性病变尺寸较大（≥30ram）及壁结节的存在与肿瘤的良恶性特征存在相关性，其OR值（95％CI）分别为5．591（3．657—8．548）、3．633（2．626-5．027）及4．983（3．872—6．412）。结论主胰管扩张（≥5ram）、囊性病变尺寸较大（≥30mm）及壁结节的存在均提示胰腺IPMN为恶性可能。胰腺IPMN的治疗应在对其临床诸多特征进行综合分析并评估其良恶性之后，结合患者的具体情况慎重决定。

Objective To study the clinical characteristics which are related to malignancy in pancreatic intraductal papillary mucinous neoplasm （IPMN） with an aim to provide evidence for clinical practice. Methods Using PubMed, all pancreatic IPMN related articles with positive pathologic re- sults before July 30th, 2011 were studied. A pooled analysis was carried out on the morphological fea- tures of the disease. The analysis included gender, diameter of main pancreatic duct, diameter of cyst- ic lesion, mural nodules and histological types （benign/malignant） of the neoplasm. Results 98 arti- cles （including 1902 cases） were collected and analyzed. 1025 cases were benign （53.89%） and 877 cases （46.11%） were malignant. Morphologically, there were a correlation between main pancreatic duct dilatation （≥5 mm）, cystic lesion of large size （≥30 mm）, presence of mural nodules and malig- nancy. The OR （95% CI） were 5.591 （3.657-8.548）, 3.633 （2.626-5.027） and 4.983 （3.872- 6. 412） respectively. Conclusions A main pancreatic duct dilatation （≥5 mm）, cystic lesions of large size （≥30 mm） and presence of mural nodules prompt the tumor to be malignant. In clinical work, the management of pancreatic IPMN should be made prudently based on comprehensive analysis of clinical features and the patient＇s status and intent.