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
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
摘要
Abstract
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.关键词
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Key words
pancreatic cystic neoplasm/intraductal papillary mucinous neoplasm of pancreas/mucinous cystic neoplasm of pancreas/surgery indication/2023 International Association of Pancreatology Kyoto Guidelines分类
医药卫生引用本文复制引用
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..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[J].中国实用外科杂志,2026,46(2):262-267,6.基金项目
国家科技重大专项-四大慢病防治研究项目(No.2025ZD0552300) （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) （No.23Y41900200）
上海市卫生健康委员会临床研究面上项目(No.202240305) （No.202240305）
海军特色医学中心特色诊疗创新技术项目(No.23TSJS04) （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) （No.24DZX13）
Shanghai Science and Technology Innovation Action Plan Medical Innovation Research Project(No.23Y41900200) （No.23Y41900200）
Special Clinical Research Project of Shanghai Municipal Health Commission(No.202240305) （No.202240305）
Naval Medical Center Characteristic Diagnosis and Treatment Innovation Technology Project(No.23TSJS04) （No.23TSJS04）
Special Research Project of Naval Medical Center(No.24DZX13) （No.24DZX13）
