2023年IAP京都指南"担忧特征"对主胰管未扩张胰腺黏液囊性肿瘤恶变诊断效能研究OA
Diagnostic performance of the number of worrisome features in the 2023 International Association of Pancreatology Kyoto Guideline for malignancy in mucin-producing pancreatic cystic neoplasms without main pancreatic duct dilation
目的 评估2023年版国际胰腺病协会(IAP)京都指南"担忧特征(WF)"在主胰管未扩张的胰腺黏液囊性肿瘤(mPCN)恶变诊断中的应用价值.方法 回顾性分析2012年1月至2023年12月于海军军医大学第一附属医院肝胆胰脾外科接受胰腺手术且术后病理诊断为分支型胰腺导管内乳头状黏液瘤(BD-IPMN)或胰腺黏液囊腺瘤(MCN)的374例病人的临床资料,评估WF在MCN、BD-IPMN和最大径＜30 mm mPCN中的恶变诊断效能,评价恶变诊断效能的参数包括敏感度、特异度、受试者工作特征曲线下面积(AUC)、约登指数和F1值.结果 所有病人中 MCN 164 例,BD-IPMN 210 例.多因素 logistic 分析结果显示,CA19-9 水平 ≥37 kU/L(OR=8.35,95％CI 2.23-31.25,P=0.002)、增强附壁结节(OR=7.60,95％CI 1.33-43.27,P=0.022)、钙化(OR=13.49,95％CI 2.77-65.75,P=0.001)和腹痛(OR=8.89,95％CI 2.30-34.34,P=0.002)是MCN恶变的独立危险因素;CA19-9水平≥37 kU/L(OR=3.25,95％CI 1.61-6.59,P=0.001)和远端胰腺萎缩(OR=2.99,95％CI 1.31-6.85,P=0.009)是 BD-IPMN 恶变的独立危险因素;CA19-9水平≥37 kU/L(OR=5.21,95％CI 2.13-12.73,P＜0.001)、囊壁增厚或强化(OR=3.57,95％CI 1.43-8.92,P=0.007)、远端胰腺萎缩(OR=7.42,95％CI 2.53-21.74,P＜0.001)和最大径增长速度≥2.5 mm/年(OR=2.85,95％CI 1.23-6.59,P=0.014)是最大径＜30 mm mPCN恶变的独立危险因素.WF≥3个诊断MCN恶变的效能最佳,AUC为0.859;WF≥2个诊断BD-IPMN和最大径＜30 mm的效能最佳,AUC分别为0.734和0.791.结论 2023年IAP京都指南WF数量可用于主胰管未扩张mPCN恶变的诊断,对MCN恶变诊断的效能最佳.
Objective To evaluate the application value of worrisome features(WF)from the 2023 Kyoto Guidelines in diagnosing malignancy for mucin-producing pancreatic cystic neoplasms(mPCNs)without main pancreatic duct dilation.Methods A retrospective analysis was conducted on the clinical data of 374 patients who underwent pancreatic surgery at the Department of Hepatobiliary Pancreatic Surgery,First Hospital Affiliated to Naval Medical University,between January 2012 and December 2023,with postoperative pathological confirmation of branch-duct intraductal papillary mucinous neoplasm(BD-IPMN)or pancreatic mucinous cystic neoplasm(MCN).The diagnostic performance of malignancy for MCN,BD-IPMN and＜30 mm mPCN was evaluated by sensitivity,specificity,area under the receiver operating characteristic curve(AUC),Youden index,and F1-score.Results Among all patients,there were 164 cases of MCN and 210 cases of BD-IPMN.Results of multivariable logistic analysis showed that CA19-9≥37 kU/L(OR=8.35,95％CI 2.23-31.25,P=0.002),enhancing mural nodule(OR=7.60,95％CI 1.33-43.27,P=0.022),calcification(OR=13.49,95％CI 2.77-65.75,P=0.001),and abdominal pain(OR=8.89,95％CI 2.30-34.34,P=0.002)were independent risk factors for malignancy of MCN.CA19-9≥37 kU/L(OR=3.25,95％CI 1.61-6.59,P=0.001)and distal pancreatic atrophy(OR=2.99,95％CI 1.31-6.85,P=0.009)were independent risk factors for malignancy of BD-IPMN.CA19-9≥37 kU/L(OR=5.21,95％CI 2.13-12.73,P＜0.001),thickened or enhanced cyst wall(OR=3.57,95％CI 1.43-8.92,P=0.007),distal pancreatic atrophy(OR=7.42,95％CI 2.53-21.74,P＜0.001),and growth rate of diameter ≥2.5 mm/year(OR=2.85,95％CI 1.23-6.59,P=0.014)were independent risk factors for malignancy in＜30 mm mPCN.The presence of ≥3 WFs demonstrated the best diagnostic performance for malignancy of MCN,with an AUC of 0.859.The presence of ≥2 WFs showed the best diagnostic performance for malignancy of BD-IPMN and＜30 mm mPCN with AUCs of 0.734 and 0.791,respectively.Conclusion The number of WFs from the 2023 Kyoto Guidelines can be used for diagnosing malignancy in mPCN without main pancreatic duct dilation,with the highest diagnostic performance observed for MCN malignancy.
李勃;周玉坤;王蓓蕾;郭世伟;金钢;康晓超;时霄寒;经纬;郑楷炼;高绥之;史美龙;袁帅;尹笑逸
海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433||中国人民解放军海军特色医学中心普外科,上海 200052中国人民解放军海军特色医学中心普外科,上海 200052海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433海军军医大学第一附属医院(上海长海医院)肝胆胰外科,上海 200433
医药卫生
胰腺黏液囊性肿瘤胰腺导管内乳头状黏液瘤胰腺黏液囊腺瘤手术指征2023年国际胰腺病协会京都指南
pancreatic cystic neoplasmintraductal papillary mucinous neoplasm of pancreasmucinous cystic neoplasm of pancreassurgery indication2023 International Association of Pancreatology Kyoto Guidelines
《中国实用外科杂志》 2026 (2)
262-267,6
国家科技重大专项-四大慢病防治研究项目(No.2025ZD0552300)上海市2023年度"科技创新行动计划"医学创新研究专项项目(No.23Y41900200)上海市卫生健康委员会临床研究面上项目(No.202240305)海军特色医学中心特色诊疗创新技术项目(No.23TSJS04)海军特色医学中心科研专项课题(No.24DZX13) Noncommunicable Chronic Diseases-National Science and Technology Major Project(No.2025ZD0552300)Shanghai Science and Technology Innovation Action Plan Medical Innovation Research Project(No.23Y41900200)Special Clinical Research Project of Shanghai Municipal Health Commission(No.202240305)Naval Medical Center Characteristic Diagnosis and Treatment Innovation Technology Project(No.23TSJS04)Special Research Project of Naval Medical Center(No.24DZX13)
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