Abstract：
BACKGROUND: Predictors of long-term survival after resection of adenocarcinoma arising from intraductal papillary mucinous neoplasms are unknown. This study determines predictors of long-term (>5 years) disease-free survival and recurrence in adenocarcinoma arising from intraductal papillary mucinous neoplasms and derives a prognostic model for disease-free survival.
METHODS: Consecutive patients who underwent pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasms in 18 academic pancreatic centers in Europe and Asia between 2010 to 2017 with at least 5-year follow-up were identified. Factors associated with disease-free survival were determined using Cox proportional hazards model. Internal validation was performed, and discrimination and calibration indices were assessed.
RESULTS: In the study, 288 patients (median age, 70 years; 52% male) were identified; 140 (48%) patients developed recurrence after a median follow-up of 98 months (interquartile range, 78.4-123), 57 patients (19.8%) developed locoregional recurrence, and 109 patients (37.8%) systemic recurrence. At 5 years after resection, the overall and disease-free survival was 46.5% (134/288) and 35.0% (101/288), respectively. On Cox proportional hazards model analysis, multivisceral resection (hazard ratio, 2.20; 95% confidence interval, 1.06-4.60), pancreatic tail location (hazard ratio, 2.34; 95% confidence interval, 1.22-4.50), poor tumor differentiation (hazard ratio, 2.48; 95% confidence interval, 1.10-5.30), lymphovascular invasion (hazard ratio, 1.74; 95% confidence interval, 1.06-2.88), and perineural invasion (hazard ratio, 1.83; 95% confidence interval, 1.09-3.10) were negatively associated with long-term disease-free survival. The final predictive model incorporated 8 predictors and demonstrated good predictive ability for disease-free survival (C-index, 0.74; calibration, slope 1.00).
CONCLUSIONS: A third of patients achieve long-term disease-free survival (>5 years) after pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasms. The predictive model developed in the current study can be used to estimate the probability of long-term disease-free survival.
METHODS: Consecutive patients who underwent pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasms in 18 academic pancreatic centers in Europe and Asia between 2010 to 2017 with at least 5-year follow-up were identified. Factors associated with disease-free survival were determined using Cox proportional hazards model. Internal validation was performed, and discrimination and calibration indices were assessed.
RESULTS: In the study, 288 patients (median age, 70 years; 52% male) were identified; 140 (48%) patients developed recurrence after a median follow-up of 98 months (interquartile range, 78.4-123), 57 patients (19.8%) developed locoregional recurrence, and 109 patients (37.8%) systemic recurrence. At 5 years after resection, the overall and disease-free survival was 46.5% (134/288) and 35.0% (101/288), respectively. On Cox proportional hazards model analysis, multivisceral resection (hazard ratio, 2.20; 95% confidence interval, 1.06-4.60), pancreatic tail location (hazard ratio, 2.34; 95% confidence interval, 1.22-4.50), poor tumor differentiation (hazard ratio, 2.48; 95% confidence interval, 1.10-5.30), lymphovascular invasion (hazard ratio, 1.74; 95% confidence interval, 1.06-2.88), and perineural invasion (hazard ratio, 1.83; 95% confidence interval, 1.09-3.10) were negatively associated with long-term disease-free survival. The final predictive model incorporated 8 predictors and demonstrated good predictive ability for disease-free survival (C-index, 0.74; calibration, slope 1.00).
CONCLUSIONS: A third of patients achieve long-term disease-free survival (>5 years) after pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasms. The predictive model developed in the current study can be used to estimate the probability of long-term disease-free survival.
摘要：
背景：导管内乳头状黏液性肿瘤引起的腺癌切除后长期生存的预测因素尚不清楚。这项研究确定了由导管内乳头状黏液性肿瘤引起的腺癌的长期（>5年）无病生存和复发的预测因素，并得出了无病生存的预后模型。
方法：在2010年至2017年期间，在欧洲和亚洲的18个学术胰腺中心，连续接受胰腺切除术的患者来自导管内乳头状粘液性肿瘤，至少5年随访。使用Cox比例风险模型确定与无病生存相关的因素。进行了内部验证,并对判别和校准指标进行了评估。
结果：在研究中，288例患者（中位年龄，70岁;52%男性);140(48%)患者在中位随访98个月后复发(四分位距,78.4-123),57例患者（19.8%）出现局部复发，109例（37.8%）全身复发。切除后5年,总生存率和无病生存率分别为46.5%(134/288)和35.0%(101/288),分别。关于Cox比例风险模型分析，多内脏切除术(危险比，2.20；95%置信区间，1.06-4.60),胰尾位置(危险比，2.34；95%置信区间，1.22-4.50),肿瘤分化差(风险比，2.48；95%置信区间，1.10-5.30),淋巴管浸润(危险比，1.74；95%置信区间，1.06-2.88),和神经周浸润(危险比，1.83；95%置信区间，1.09-3.10）与长期无病生存率呈负相关。最终的预测模型纳入了8个预测因子，并证明了对无病生存的良好预测能力(C指数，0.74;校准,坡度1.00)。
结论：由于导管内乳头状黏液性肿瘤引起的腺癌，1/3的患者在胰腺切除术后获得长期无病生存(>5年)。当前研究中开发的预测模型可用于估计长期无病生存的概率。
方法：在2010年至2017年期间，在欧洲和亚洲的18个学术胰腺中心，连续接受胰腺切除术的患者来自导管内乳头状粘液性肿瘤，至少5年随访。使用Cox比例风险模型确定与无病生存相关的因素。进行了内部验证,并对判别和校准指标进行了评估。
结果：在研究中，288例患者（中位年龄，70岁;52%男性);140(48%)患者在中位随访98个月后复发(四分位距,78.4-123),57例患者（19.8%）出现局部复发，109例（37.8%）全身复发。切除后5年,总生存率和无病生存率分别为46.5%(134/288)和35.0%(101/288),分别。关于Cox比例风险模型分析，多内脏切除术(危险比，2.20；95%置信区间，1.06-4.60),胰尾位置(危险比，2.34；95%置信区间，1.22-4.50),肿瘤分化差(风险比，2.48；95%置信区间，1.10-5.30),淋巴管浸润(危险比，1.74；95%置信区间，1.06-2.88),和神经周浸润(危险比，1.83；95%置信区间，1.09-3.10）与长期无病生存率呈负相关。最终的预测模型纳入了8个预测因子，并证明了对无病生存的良好预测能力(C指数，0.74;校准,坡度1.00)。
结论：由于导管内乳头状黏液性肿瘤引起的腺癌，1/3的患者在胰腺切除术后获得长期无病生存(>5年)。当前研究中开发的预测模型可用于估计长期无病生存的概率。
