摘要：
目的 探讨影响浸润型胰腺导管内乳头状黏液瘤(IPMNs)患者预后的因素.方法 采用回顾性病例对照研究方法.收集2005年6月至2014年4月复旦大学附属中山医院收治的110例经术后病理学检查证实的胰腺IPMNs患者的临床资料,筛选出符合条件的浸润型胰腺IPMNs患者41例.患者术后参照胰腺导管腺癌化疗方案进行化疗.采用门诊和电话方式进行随访,了解患者生存情况.随访时间截至2016年2月.分析指标:(1)随访情况:患者1、3、5年生存率.(2)预后因素分析指标:性别、年龄、肿瘤部位、手术方式、肿瘤直径、T分期、神经侵犯、淋巴结侵犯、切缘异型、组织病理学亚型、癌变病理学类型.(3)分层分析:对独立预后因素进行分层分析.采用Kaplan-Meier法绘制生存曲线、计算生存率.采用x2检验进行单因素分析.采用COX回归模型进行多因素分析.采用Log-rank检验进行生存分析.结果 (1)随访情况:41例浸润型胰腺IPMNs患者均获得术后随访.随访时间为4.3 ～125.8个月,中位随访时间为26.4个月.41例患者中位生存时间为32.8个月,1、3、5年生存率分别为90％、45％、39％.(2)预后因素分析:单因素分析结果显示:神经侵犯、淋巴结侵犯是影响浸润型胰腺IPMNs患者术后预后的相关因素(x2=5.996,11.552,P＜0.05).多因素分析结果显示:淋巴结侵犯是影响浸润型胰腺IPMNs患者术后预后不良的独立危险因素(HR =3.111,95％可信区间:1.271～7.614,P＜0.05).(3)分层分析:29例淋巴结阴性患者中位生存时间为56.9个月,1、3、5年生存率分别为97％、57％、49％;12例淋巴结阳性患者中位生存时间为14.4个月,1、3、5年生存率分别为75％、15％、15％.两者生存情况比较,差异有统计学意义(x2=11.552,P ＜0.05).结论 组织病理学亚型及癌变病理学类型对评估浸润型胰腺IPMNs患者预后价值有限,而淋巴结阳性是浸润型胰腺IPMNs患者预后不良的独立危险因素.%Objective To evaluate the prognostic factors of invasive intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Methods The retrospective case-control study was adopted.The clinical data of 110 patients who were confirmed as with IPMN of the pancreas by pathological examination at the Zhongshan Hospital of Fudan University from June 2005 to April 2014 were collected.Forty-one patients with invasive IPMN were screened for eligibility.Patients underwent chemotherapy according to the chemotherapy regimens of pancreatic ductal adenocarcinoma.The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients by tumor markers,B-ultrasound and computed tomography (CT) once every half year up to February 2016.Analysis indicators included (1) follow-up situation:1-,3-,5-year survival rates,(2) prognostic factors:gender,age,tumor location,surgical procedures,tumor diameter,T stage,nerve invasion,lymph node invasion,heteromorphic resection margin,histopathological subtypes,pathological type of canceration,(3) stratified analysis:independent prognostic factors.The survival curve was drawn by the KaplanMeier method.Survival rate was calculated and univariate analysis was analyzed by the chi-square test.The multivariate analysis was done using the COX regression model,and survival analysis was done by the Log-rank test.Results (1) Follow-up:41 patients with invasive IPMN of the pancreas were followed up for 4.3-125.8months with a median follow-up time of 26.4 months,and median survival time and 1-,3-,5-year survival rates were respectively 32.8 months,90％,45％ and 39％.(2) Analysis of prognostic factors:the results of univariate analysis showed that nerve invasion and lymph node invasion were related factors affecting the prognosis of patients with invasive IPMN of the pancreas (x2 =5.996,11.552,P ＜ 0.05).The results of multivariate analysis showed that lymph node invasion was an independent risk factor affecting the poor prognosis of patients with invasive IPMN of the pancreas (HR =3.111,95％ confidence interval:1.271-7.614,P＜0.05).(3) The stratified analysis:a median survival time and 1-,3-,5-year survival rates were respectively 56.9 months,97％,57％,49％ in 29 patients with negative lymph nodes and 14.4 months,75％,15％,15％ in 12 patients with positive lymph nodes,with a statistically significant difference (x2 =11.552,P ＜ 0.05).Conclusion The histopathological subtypes and pathological type of canceration have limited prognostic value on invasive IPMN of the pancreas,however,the positive lymph nodes are an independent risk factor affecting the poor prognosis of patients with invasive IPMN of the pancreas.
