Analysis Of The Prognosis And Influencing Factors Of Intraductal Papillary Mucinous Neoplasm Of Bile Duct After Surgical Therapy

Objective To explore the prognosis and influencing factors of intraductal papillary mucinous neoplasm of the bile duct?IPMN-B?after surgical therapy,so as to provide valuable references for clinical diagnosis and treatment.Methods Clinical datas of 50 patients who were diagnosed pathologically with IPMN-B in Hunan Provincial People's Hospital from January 1,2012 to December 31,2017 were restrospectively analyzed in the end,including:gender,age,liver function,jaundice or not,bile duct caculus or not,and tumor-associated factors?eg.tumor location,CA19-9,CA242,operation method,lymphatic metastasis or not,surgical margin status,etc.?.Patients were followd up by telephone or outpatient to know whether they had recurrent jaundice,neoplasm recurrence and what was the quality of their life postoperative.The deadline for the follow-up was the death of IPMN-B or on December 31,2019.Result According to the pathological examination,there were9 cases of benign tumor and 41 cases of malignant neoplasm?23cases of focal invasive carcinoma and 18 cases of related invasive carcinoma?;The results of indicators related to tumor,such as CA19-9 and CA242,differentiate beween two groups before operation,which CA19-9 and CA242 in malignant tumor group were higher than those in benign tumor group,statistically significant.(t_CA199=-2.435,t_CA242=-2.438,P<0.05);ROC curve showed that the reliability of preoperative CA242 in diagnosis of malignant IPMN-B?area under curve:0.726?was higher than CA19-9?area under curve:0.657?.As for differences in age,gender,jaundice or not,bile duct stones or not,liver function and carcinoma location between the two groups,there were no statistical significance.As to surgery-associated condition,no significant differences in operation time,time of blocking hepatic portal,hospital stays,resction range of liver,blood loss during operation and complications postoperative between two groups,without statistically significance?P>0.05?.According to Clavien-Dindo Grading System,the incidence rate of postoperative complications of grade III_a?bile leakage,ascites and pleural effusion.?was 6.0%.There was no patient with complications graded III_bor above.No patient died perioperative.All 50 patients were followed up during the follow-up period,and the median follow-up time was 49 months?25-91 months?.Survival analysis showed there were no deaths in the adenoma group,but 10 in the adenocarcinoma group by the deadline.The overall survival rates of 1-year,3-year and5-year were respectively 95.1%,85.4%and 75.6%.The median survival time was 53.5 months.There were obvious differences between the two groups,statistically significant?F=1.362,t=0.389,P<0.05?;Univariate survival analysis showed that sugical methods and surgical margin conditions were the factors influencing the long-term prognosis of patients?P<0.05?,while age,gender,CA19-9,CA242 and jaundice made no difference to the long-term prognosis?P>0.05?.Multivariate analysis showed that radical resection was an independent risk factor to IPMN-B,Which was proved to be malignant.?HR=11.683,95%confidence interval:1 253?108.91,P<0.05?.Conclusion 1.Prognosis of patients with malignant IPMN-B is good overall.The 5-year survival rate after radical resection is good.2.We could detected the level of CA19-9 and CA242elevated in both two groups,higher the level of CA19-9 and CA242,the more likely IPMN-B is proved to be maliganant.