| Objectives:In this article,we compared the clinical features(age,gender,tumor diameter,main pancreatic duct diameter,type of affected pancreatic ducts,Ki-67 index,carbohydrate antigen 19-9,carbohydrate antigen 12-5,carcinoembryonic antigen,serum ferritin,blood type,neutrophil to lymphocyte ratio,systemic immune inflammation index,etc.)of patients with intraductal papillary mucinous neoplasm of the pancreas with their pathological features(benign intraductal papillary mucinous neoplasm or malignant intraductal papillary mucinous neoplasm),aims to study clinical significances of these clinical features,so as to find the predictive factors that can judge the benign and malignant intraductal papillary mucinous neoplasm before operation,provide reference for the monitoring and treatment of intraductal papillary mucinous neoplasm,and help the early detection and treatment of pancreatic ductal adenocarcinoma.Methods:A total of 48 patients who underwent surgical treatment and were confirmed as intraductal papillary mucinous neoplasm of the pancreas by postoperative pathological examination in the Second Affiliated Hospital of Kunming Medical University from December 2015 to December 2022 and had complete medical records were included in the study.According to the pathological classification criteria in the2019 World Health Organization Classification of Gastrointestinal Tumor(Version 5),intraductal papillary mucinous neoplasm with low-grade dysplasia were classified as the benign group and intraductal papillary mucinous tumors with high-grade dysplasia or associated invasive carcinoma as the malignant group.The statistical comparison and analysis of the clinical characteristics between the two groups were performed to find the predictors of malignant intraductal papillary mucinous tumors and calculate the corresponding cutoff values.Results:A total of 48 patients of IPMN underwent operation were enrolled in this study,with the average age of 59.25±9.43 years old,among which the youngest patient was36 years old and the oldest patient was 78 years old.There were 34 males and 14 females,with the ratio of male to female being 2.43: 1.There were 36 cases of benign IPMN and 12 cases of malignant IPMN.Univariate binary logistic regression analysis was used to analyze the factors that may predict the benign and malignant behavior of IPMN and concluded that the main pancreatic duct diameter [OR = 1.654,95% CI(1.149,2.382),P = 0.007],Ki-67 index [OR = 1.300,95% CI(1.079,1.567),P =0.006],serum CA19-9 level [OR=1.042,95%CI(1.007,1.078),P=0.017] 、SSI[OR=23.269,95%CI(1.441,383.649),P=0.028],whether the cyst wall was thickened [or = 11.000,95% CI(1.283,94.324),and p = 0.029] were risk factors for malignant IPMN.According to ROC,the optimal cutoff values were as follows: main pancreatic duct diameter ≥4.9mm,Ki-67 index ≥17.5%,serum CA19-9 level ≥46.97KU/L,and SII≥0.57.Conclusions:1.This study showed that the diameter of main pancreatic duct,Ki-67 index,serum CA19-9 level,SII and whether the cyst wall was thickened had a significant correlation with the pathological properties of IPMN.2.It was concluded from the analysis of this study that the diameter of main pancreatic duct,Ki-67 index,serum CA19-9 level,SII and whether the cyst wall was thickened were the risk factors for malignant IPMN,which could be used as predictive factors to distinguish between benign and malignant IPMN.In preoperative patients with wall thickening,main pancreatic duct diameter ≥4.9mm,Ki-67 index ≥17.5%,serum CA19-9 level≥46.97KU/L and SII≥0.57,IPMN was more likely to be malignant and surgical resection should be preferred to prevent PDAC.3.The preoperative evaluation value of KI-67 index is limited. |
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