A prediction rule for estimating pancreatic cancer risk in chronic pancreatitis patients with focal pancreatic mass lesions with prior negative EUS-FNA cytology

被引:15
作者
Cai, Quan-Cai [1 ,2 ]
Chen, Yan [1 ]
Xiao, Yi [3 ]
Zhu, Wei [1 ,2 ]
Xu, Qin-Feng [4 ]
Zhong, Liang [5 ]
Chen, Shi-Yao [6 ]
Zhang, Min-Min [1 ]
Wang, Luo-Wei [1 ]
Li, Zhao-Shen [1 ,2 ]
机构
[1] Second Mil Med Univ, Changhai Hosp, Dept Gastroenterol, Shanghai 200433, Peoples R China
[2] Second Mil Med Univ, Ctr Clin Epidemiol & Evidence Based Med, Shanghai 200433, Peoples R China
[3] Second Mil Med Univ, Changhai Hosp, Dept Radiol, Shanghai 200433, Peoples R China
[4] Fudan Univ, Dept Stat, Shanghai 200433, Peoples R China
[5] Fudan Univ, Huashan Hosp, Dept Gastroenterol, Shanghai 200433, Peoples R China
[6] Fudan Univ, Zhongshan Hosp, Dept Gastroenterol, Shanghai 200433, Peoples R China
基金
中国国家自然科学基金;
关键词
Chronic pancreatitis; pancreatic cancer; prediction rule; risk stratification; FINE-NEEDLE-ASPIRATION; ENDOSCOPIC ULTRASONOGRAPHY; GUIDED FNA; ULTRASOUND; MALIGNANCY; DIAGNOSIS; BIOPSY; ADENOCARCINOMA; VALIDATION; MODELS;
D O I
10.3109/00365521.2010.539256
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective. Considerable false-negative endoscopic ultrasound guided fine needle aspiration (EUS-FNA) findings exist in chronic pancreatitis patients with focal pancreatic mass lesions. Our aim was to develop a prediction rule to stratify risk for pancreatic cancer in chronic pancreatitis patients with focal pancreatic mass lesions with prior negative EUS-FNA cytology. Material and methods. A total of 138 eligible consecutive patients were identified from three hospitals between January 2000 and May 2008. A final diagnosis of pancreatic mass lesions was confirmed histologically or verified by a follow-up of at least 12 months. A prediction rule was developed from a logistic regression model by using a regression coefficient-based scoring method, and then internally validated by using bootstrapping. Results. The rate of pancreatic cancer in the cohort was 18.1%. The prediction rule, which was scored from 0 to 10 points, comprised five variables: sex, mass location, mass number, direct bilirubin, and CA 19-9. Among the 87.7% of patients with low-risk scores (< a parts per thousand currency sign3), the risk of pancreatic cancer was 13.2%; by comparison, this risk was 52.9% (p < 0.001) among the 12.3% of patients with high-risk scores (> 3). If further invasive tests were used for patients with high risk, 36% of patients with pancreatic cancer would not be missed. The prediction rule had good discrimination (area under the receiver operating characteristic curve, 0.72) and calibration (p == 0.96). Conclusions. The prediction rule can provide available risk stratification for pancreatic cancer in chronic pancreatitis patients with focal mass lesions with prior negative EUS-FNA cytology. Application of risk stratification may improve clinical decision making.
引用
收藏
页码:464 / 470
页数:7
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