胰腺导管内乳头状黏液性肿瘤免疫组织化学类型与病理学类型的Meta分析

Relationship between the immunohistochemical types and the pathological types of pancreatic intraductal 2papillary mucinous neoplasms: a meta analysis

  • 摘要: 目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)免疫组织化学类型与病理学类型的关系。方法 检索PubMed全文数据库公开发表的胰腺IPMN临床诊断和治疗的相关文献;检索文献发表时间至2011年6月30日。采用病例报告质量评估清单对纳入文献进行评分。对胰腺IPMN免疫组织化学类型与性别、病理学类型、肿瘤良恶性特征、形态学类型进行相关性分析。二分类变量采用Pearsonχ2检验,多变量相关性分析采用多元回归方程检验。结果 共纳入13篇文献,质量评价得分为31~45分(满分50分),平均得分37分,获得经病理检查确诊的826例胰腺IPMN患者的资料。免疫组织化学分型共4型:(1)胃型患者363例,271例进行性别分析的患者中,男195例、女76例;中位年龄65.6岁。225例进行病理学分型的患者中,腺瘤146例、交界性肿瘤34例、原位癌24例、浸润性癌21例。其中良性肿瘤占86.68%(293/338)。215例进行形态学分型的患者中,主胰管型34例、支胰管型151例、混合型30例。(2)肠型患者327例,269例进行性别分析的患者中,男184例、女85例;中位年龄64.5岁。262例进行病理学分型的患者中,腺瘤28例、交界性肿瘤43例、原位癌91例、浸润性癌100例。其中良性肿瘤占29.21%(85/291)。151例进行形态学分型的患者中,主胰管型63例、支胰管型54例、混合型34例。(3)胰胆型患者92例,78例进行性别分析的患者中,男41例、女37例;中位年龄69.2岁。81例进行病理学分型的患者中,腺瘤4例、交界性肿瘤1例、原位癌21例、浸润性癌55例,其中良性肿瘤占5.75%(5/87)。34例进行形态学分型的患者中,主胰管型7例、支胰管型18例、混合型9例。(4)嗜酸细胞型患者44例,37例进行性别分析的患者中,男24例、女13例;中位年龄60.3岁。33例进行病理学分型的患者中,原位癌18例、浸润性癌15例,均为恶性肿瘤;36例进行形态学分型的患者中,主胰管型9例、支胰管型16例、混合型11例。胰腺IPMN的免疫组织化学类型与性别、病理学类型、肿瘤良恶性存在相关性(χ2=10.626,281.839,333.212,r=0.097,0.569,0.625,P<0.05)。虽然胰腺IPMN的免疫组织化学类型与其形态学类型间的Pearson χ2检验结果有统计学意义(χ2=50.732,P<0.05),但两者无线性相关性(r=0.010,P>0.05)。结论 胰腺IPMN免疫组织化学类型有其自身特点,与性别、病理学类型、肿瘤良恶性存在相关性,可为治疗及预后评估提供参考。

     

    Abstract: Objective To investigate the relationship between the immunohistochemical types and the pathological types of pancreatic intraductal papillary mucinous neoplasms (IPMN). Methods Literatures on the diagnosis and treatment of pancreatic IPMN published before June 30, 2011 in the PubMed database were retrieved. The literatures adopted were scored by the case reports quality assessment list. The correlation analysis between the immunohistochemical types and the gender, pathological types, characteristics of benign or malignant tumor and morphological types were analyzed. All data were analyzed using the Pearson chisquare test or multiple regression analysis. Results Thirteen literatures were adopted, the scores were 3145 (full mark: 50), and the mean score was 37. The clinical data of 826 pancreatic IPMN patients who were comfirmed by pathological examination were collected, and there were 4 immunohistochemical types: (1) The gastric type (363 patients). Of the 271 patients who underwent gender analysis, there were 195 males and 76 females, with the median age of 65.6 years. Of 225 patients who underwent pathological types analysis, there were 146 cases of adenoma, 34 cases of borderline tumor, 24 cases of carcinoma in situ, 21 cases of invasive carcinoma, the benign tumor was accounted for 86.68%(293/338). Of the 215 patients who underwent morphological type analysis, there were 34 cases of main pancreatic duct type, 151 cases of branch duct type and 30 cases of mixed type. (2) The intestinal type (327 patients). Of the 269 patients who underwent gender analysis, there were 184 males and 85 females, with the median age of 64.5 years. Of the 262 patients who underwent pathological types analysis, there were 28 cases of adenoma, 43 cases of borderline tumor, 91 cases of carcinoma in situ, 100 cases of invasive carcinoma, the benign tumor was accounted for 29.21%(85/291). Of the 151 patients who underwent morphological type analysis, there were 63 cases of main pancreatic duct type, 54 cases of branch duct type and 34 cases of mixed type. (3) The pancreatobiliary type (92 patients). Of the 78 patients who underwent gender analysis, there were 41 males and 37 females, with the median age of 69.2 years. Of the 81 patients who underwent pathological types analysis, there were 4 cases of adenoma, 1 case of borderline tumor, 21 cases of carcinoma in situ, 55 cases of invasive carcinoma, the benign tumor was accounted for 5.75%(5/87). Of the 34 patients who underwent morphological type analysis, there were 7 cases of main pancreatic duct type, 18 cases of branch duct type and 9 cases of mixed type. (4) The oncocytic type (44 patients). Of the 37 patients who underwent gender analysis, there were 24 males and 13 females, with the median age of 60.3 years. Of the 33 patients who underwent pathological types analysis, there were 18 cases of carcinoma in situ, 15 cases of invasive carcinoma, and all of them were with malignant tumors. Of the 36 patients who underwent morphological type analysis, there were 9 cases of main pancreatic duct type, 16 cases of branch duct type and 11 cases of mixed type. The immunohistochemical type of pancreatic IPMN was correlated with gender, pathological type and characteristics of maglignant or benign tumors (χ2=10.626, 281.839, 333.212, r=0.097, 0.569, 0.625, P<0.05). The result of the chisquare test between the immunohistochemical types and the morphological types was statistically significant (χ2=50.732, P<0.05), but there was no correlation between them (r=0.010, P>0.05). Conclusion The immunohistochemical type of pancreatic IPMN is correlated with gender, pathological type and the characteristics of maglignant or benign tumors, which provide references for the diagnosis and prognosis evaluation of pancreatic IPMN.

     

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