胰腺导管内乳头状黏液性肿瘤相关浸润性癌临床病理及预后因素分析

Intraductal papillary mucinous neoplasm with an associated invasive carcinoma of the pancreas: analysis of the clinicopathologic features and prognosis

目的 :探讨胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)相关浸润性癌患者的临床病理特征及预后特点。方法:回顾性分析52例胰腺IPMN相关浸润性癌患者的临床资料和病理学特征,并随访其生存情况。结果:52例患者的中位发病年龄为65岁;36例患者的肿瘤发生在胰头部,15例发生在胰体尾部,1例为全胰导管内均有病变。IPMN类型包括,23例胃型,12例肠型,9例胆胰型,7例混合型("胃型"+"胆胰型"),1例嗜酸细胞型;浸润性癌类型包括37例导管腺癌,13例胶样癌,1例未分化癌和1例腺鳞癌。血清CA19-9升高的情况在导管腺癌患者中更为显著,浸润性癌类型为导管腺癌患者的CA19-9阳性率为67.57%(25/37),而浸润型癌类型为胶样癌的患者中CA19-9阳性率为30.77%(4/13)。43例获得随访资料的患者中,无淋巴结转移的患者共30例,中位生存时间较13例淋巴结转移患者(39个月比13个月)长,差异有统计学意义(P<0.05);肿瘤局限于胰腺内的21例患者,其中位生存时间较肿瘤浸润胰腺外的22例患者长(45个月比24个月),差异有统计学意义(P<0.05)。43例患者获得随访,中位随访时间为16个月(5~57个月),其中1例复发,17例死亡。结论 :胰腺IPMN相关浸润性癌类型以导管腺癌为主,而血清CA19-9升高与浸润性癌类型相关。淋巴结转移及肿瘤胰腺外侵犯是胰腺IPMN相关浸润性癌患者预后不良的危险因素。

Objective： To evaluate the clinicopathologic features and prognosis of intraductal papillary mucinous neoplasm with an associated invasive carcinoma of the pancreas. Methods： The clinical data, pathological features and prognosis of 52 patients were studied retrospectively. Results： Of all the 52 cases, 36 lesions were located in the head of pancreas, 15 were in the body/tail, and 1 was in the entire length of the pancreatic duct. The median age of these patients was 65 years. Of the 52 IPMNs, 23 cases were the gastric type, 12 cases were intestinal, 9 cases were pancreatobiliary, 7 cases were mixed type （gastric＋pancreatobiliary type） and 1 case was oncocytic. The types of invasive carcinoma in- cluded 37 cases of ductal adenocarcinomas, 13 cases of colloid carcinomas, 1 cases of undifferentiated carcinoma and 1 cases of adenosquamous carcinoma. Elevated serum CA19-9 level was more frequent in patients with ductal adenocarci- noma. Nine of 52 patients were lost to follow-up. The median postoperative follow-up period was 16 months （range 5-57 months）. Conclusions： The intraductal papillary mncinous neoplasm with an associated invasive carcinoma of the pancreas are mainly ductal adenocarcinoma. Elevated serum CA19-9 level is associated with the types of the invasive carcinoma. The positive lymph nodes and tumor extending beyond pancreas are risk factors for the poor prognosis.