Abstract：
BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant neoplasm that can involve both the intrahepatic and extrahepatic bile ducts. Owing to the low incidence and confusing nomenclature, its clinicopathological features remain controversial. Additionally, only a few studies have reported on the long-term prognosis of IPNB to date. Therefore, the present study aimed to clarify the clinicopathological characteristics and prognosis of IPNB.
METHODS: Medical records of patients with IPNB treated at our hospital between August 2000 and October 2021 were retrospectively reviewed. A database of demographic characteristics, test results, surgical details, pathological findings, and follow-up information was constructed for analysis. Patients were divided into intrahepatic and extrahepatic groups, and dysplasia and invasive carcinoma groups for comparison. Differences between study groups were analyzed using the χ2 test, Fisher\'s exact test, t-test, or Mann-Whitney U test, as appropriate. Cumulative survival rates were estimated using the Kaplan-Meier method.
RESULTS: In total, 43 patients (21 men and 22 women) with IPNB were included in the study. The median age at diagnosis was 62 (54-69) years. Thirty-eight patients underwent surgery. The mean operation time was (269.5 ± 94.9) min. Five patients underwent endoscopic retrograde cholangiopancreatography for biopsy. Twenty-one and 22 patients had intrahepatic and extrahepatic lesions, respectively. The extrahepatic group had more patients with intraluminal masses (p = 0.021) and abnormal bilirubin levels (p = 0.001), but fewer patients with hepatolithiasis (p = 0.021). The operation time was longer in patients with extrahepatic lesions (p = 0.002). Twenty patients had dysplasia and 23 had invasive carcinoma. The invasive carcinoma group had a longer operation time than the dysplasia group (p = 0.004). As of March 2022, 39 patients were followed up, with a mean follow-up time of (56.2 ± 38.2) months. Fifteen patients survived without tumors, two survived with tumors, and 22 patients died. The 1-, 3-, 5-, and 10-year cumulative overall survival rates were 86.9%, 65.8%, 49.8%, and 32.0%, respectively.
CONCLUSIONS: IPNB is a rare bile duct disease that occurs mainly in patients with advanced age. Surgery is the primary treatment strategy. Intrahepatic and extrahepatic lesions, as well as dysplasia and invasive carcinoma have their own unique characteristics. The long-term prognosis of IPNB is generally poor.
METHODS: Medical records of patients with IPNB treated at our hospital between August 2000 and October 2021 were retrospectively reviewed. A database of demographic characteristics, test results, surgical details, pathological findings, and follow-up information was constructed for analysis. Patients were divided into intrahepatic and extrahepatic groups, and dysplasia and invasive carcinoma groups for comparison. Differences between study groups were analyzed using the χ2 test, Fisher\'s exact test, t-test, or Mann-Whitney U test, as appropriate. Cumulative survival rates were estimated using the Kaplan-Meier method.
RESULTS: In total, 43 patients (21 men and 22 women) with IPNB were included in the study. The median age at diagnosis was 62 (54-69) years. Thirty-eight patients underwent surgery. The mean operation time was (269.5 ± 94.9) min. Five patients underwent endoscopic retrograde cholangiopancreatography for biopsy. Twenty-one and 22 patients had intrahepatic and extrahepatic lesions, respectively. The extrahepatic group had more patients with intraluminal masses (p = 0.021) and abnormal bilirubin levels (p = 0.001), but fewer patients with hepatolithiasis (p = 0.021). The operation time was longer in patients with extrahepatic lesions (p = 0.002). Twenty patients had dysplasia and 23 had invasive carcinoma. The invasive carcinoma group had a longer operation time than the dysplasia group (p = 0.004). As of March 2022, 39 patients were followed up, with a mean follow-up time of (56.2 ± 38.2) months. Fifteen patients survived without tumors, two survived with tumors, and 22 patients died. The 1-, 3-, 5-, and 10-year cumulative overall survival rates were 86.9%, 65.8%, 49.8%, and 32.0%, respectively.
CONCLUSIONS: IPNB is a rare bile duct disease that occurs mainly in patients with advanced age. Surgery is the primary treatment strategy. Intrahepatic and extrahepatic lesions, as well as dysplasia and invasive carcinoma have their own unique characteristics. The long-term prognosis of IPNB is generally poor.
摘要：
背景：胆管导管内乳头状肿瘤（IPNB）是一种可累及肝内和肝外胆管的癌前肿瘤。由于发病率低，术语混乱，其临床病理特征仍存在争议。此外,迄今为止,只有少数研究报道了IPNB的长期预后.因此,本研究旨在阐明IPNB的临床病理特征及预后。
方法：回顾性分析2000年8月至2021年10月在我院接受治疗的IPNB患者的病历。人口统计特征的数据库，测试结果,手术细节,病理结果，并构建后续信息进行分析。患者分为肝内和肝外组，和异型增生和浸润性癌组进行比较。使用χ2检验分析研究组之间的差异，费希尔的精确检验，t检验,或者Mann-WhitneyU测试,视情况而定。使用Kaplan-Meier方法估计累积生存率。
结果：总计，43名IPNB患者（21名男性和22名女性）被纳入研究。诊断时的中位年龄为62（54-69）岁。38名患者接受了手术。平均手术时间(269.5±94.9)min。5例患者接受了内镜逆行胰胆管造影术进行活检。21例和22例患者有肝内和肝外病变，分别。肝外组有更多的患者腔内肿块（p=0.021）和异常胆红素水平（p=0.001），但肝胆管结石患者较少（p=0.021）。肝外病变患者的手术时间更长（p=0.002）。20例患有异型增生，23例患有浸润性癌。浸润性癌组的手术时间长于异型增生组（p=0.004）。截至2022年3月，对39例患者进行了随访，平均随访时间（56.2±38.2）个月。15名患者没有肿瘤存活，两个肿瘤存活下来，22名患者死亡。1-,3-,5-,10年累计总生存率为86.9%，65.8%,49.8%,和32.0%，分别。
结论：IPNB是一种罕见的胆管疾病，主要发生于高龄患者。手术是主要的治疗策略。肝内和肝外病变，以及异型增生和浸润性癌有其独特的特点。IPNB的长期预后一般较差。
方法：回顾性分析2000年8月至2021年10月在我院接受治疗的IPNB患者的病历。人口统计特征的数据库，测试结果,手术细节,病理结果，并构建后续信息进行分析。患者分为肝内和肝外组，和异型增生和浸润性癌组进行比较。使用χ2检验分析研究组之间的差异，费希尔的精确检验，t检验,或者Mann-WhitneyU测试,视情况而定。使用Kaplan-Meier方法估计累积生存率。
结果：总计，43名IPNB患者（21名男性和22名女性）被纳入研究。诊断时的中位年龄为62（54-69）岁。38名患者接受了手术。平均手术时间(269.5±94.9)min。5例患者接受了内镜逆行胰胆管造影术进行活检。21例和22例患者有肝内和肝外病变，分别。肝外组有更多的患者腔内肿块（p=0.021）和异常胆红素水平（p=0.001），但肝胆管结石患者较少（p=0.021）。肝外病变患者的手术时间更长（p=0.002）。20例患有异型增生，23例患有浸润性癌。浸润性癌组的手术时间长于异型增生组（p=0.004）。截至2022年3月，对39例患者进行了随访，平均随访时间（56.2±38.2）个月。15名患者没有肿瘤存活，两个肿瘤存活下来，22名患者死亡。1-,3-,5-,10年累计总生存率为86.9%，65.8%,49.8%,和32.0%，分别。
结论：IPNB是一种罕见的胆管疾病，主要发生于高龄患者。手术是主要的治疗策略。肝内和肝外病变，以及异型增生和浸润性癌有其独特的特点。IPNB的长期预后一般较差。
