胰管内乳头状黏液性肿瘤的术前良、恶性与浸润性预测因子

目的 分析术前预测胰管内乳头状黏液性肿瘤(IPMN)良、恶性与浸润性的因子,及不同病理类型IPMN的手术后生存率.方法 回顾性分析长海医院1993年1月至2009年9月间手术切除的78例IPMN病例资料,采用单因素与多因素分析的方法分析病史、临床表现、肝功能、CEA、CA19-9、影像学征象等在术前判断IPMN良、恶性与浸润性的价值,分析患者术后生存率.结果 单因素分析结果显示,黄疸、急性胰腺炎、血CA19-9>37 U/ml、AKP、肿块边界不清为恶性及浸润性预测因子;主胰管扩张、分支胰管直径>30 mm、出现壁节结等为恶性预测因子;CEA>6 ng/ml为浸润性预测因子.多因素分析显示,肿块边界不清为恶性及浸润性预测因子;急性胰腺炎为浸润性预测因子.良性IPMN患者的5年生存率为100%;恶性IPMN的2年生存率为78.9%、5年生存率为68.5%,其中浸润性IPMN的2年生存率为64.6%、5年生存率为43.1%.结论 肿块边界不清为IPMN恶性预测因子,急性胰腺炎、肿块边界不清是IPMN的浸润性预测因子.

Preoperative predictors of malignancy and invasive carcinoma in intraductal papillary mucinous neoplasms

Objective To investigate the predictive factors for malignancy and invasive carcinoma of IPMN, and the survival rates of different pathological type of IPMN were compared. Methods Seventy-eight patients with IPMN admitted to Changhai Hospital from January 1993 to September 2009, who underwent surgery with histological evidence were retrospectively analyzed. The univariate and multivariate analysis of potential predictive factors, including medical history, clinical presentations, liver function, CEA, CA19-9,and imaging findings was conducted to identify the predictive factors for malignancy and invasive carcinoma of IPMN. Results Univariate analysis identified jaundice, acute pancreatitis history, CA19-9 Level > 37U/ml,AKP, unclear border of tumour as independent predictive factors for malignancy and invesiveness, main pancreatic duct dilation, branch pancreatic duct diameter > 30 mm, presence of mural modules were identified as malignancy predictor. CEA > 6 ng/ml was identified as invasive carcinoma predictor. Multivariate analysis identified one independent predictive factor for malignancy or invasive carcinoma: unclear border of tumour.Another factor of invasive IPMN was acute pancreatitis. The 5 year survival rate for benign 1PMN was 100%,while 2 year survival rate for malignant IPMN was 78.9%, 5 year survival rate was 68.5%. The 2 year survival rate for invasive IPMN was 64.6%, 5 year survival rate was 43.1%. Conclusions Unclear border of tumour was predictive factors for malignancy; acute pancreatitis and unclear border of tumour were predictive factors for invasive carcinoma.