Lévy Philippe, Jouannaud Vincent, O'Toole Dermot, Couvelard Anne, Vullierme Marie Pierre, Palazzo Laurent, Aubert Alain, Ponsot Philippe, Sauvanet Alain, Maire Frédérique, Hentic Olivia, Hammel Pascal, Ruszniewski Philippe
Pôle des Maladies de L'Appareil Digestif, Service de Gastroentérologie-Pancrétologie, Hôpital Beaujon, Clichy, France.
Clin Gastroenterol Hepatol. 2006 Apr;4(4):460-8. doi: 10.1016/j.cgh.2006.01.018.
BACKGROUND & AIMS: Natural history of intraductal papillary mucinous tumors of the pancreas (IPMTs) is unknown. Cross-sectional studies suggest that exclusive branch duct (BD) involvement is associated with a lower risk of carcinoma than main pancreatic duct (MPD) involvement. The aim of our study was to calculate longitudinal risk of malignant transformation of IPMT since the first sign.
All the patients with a diagnosis of highly probable or histologically proven IPMT were included. Actuarial risks of occurrence of at least low-grade dysplasia (>or=LGD), high-grade dysplasia (>or=HGD), or invasive carcinoma (IC) were calculated by Kaplan-Meier method from the first sign attributable to IPMT. The risks according to sex, acute pancreatitis, tumor size, and involvement of MPD were compared by log-rank test.
One hundred six patients were included with a proven (n = 76) or probable (n = 30) IPMT. The tumor was confined to BD in 53 cases. Median duration since the onset of the first sign to the end of follow-up was 21 months (range, 0-241). Ten-year actuarial risk that IPMT grade was >or=LGD, >or=HGD, or IC was 67%, 49%, and 29%, respectively. The only morphologic risk factor of malignant transformation was involvement of MPD, with a 5-year actuarial risk of >or=HGD of 63% in the MPD group compared with 15% in the BD group (P < .001).
Longitudinal risk of at least HGD or IC is time-dependent. Patients with BD IPMT present a much lower risk, justifying a nonoperative surveillance.
胰腺导管内乳头状黏液性肿瘤（IPMTs）的自然病程尚不清楚。横断面研究表明，单纯分支导管（BD）受累与主胰管（MPD）受累相比，癌变风险较低。我们研究的目的是计算自首次出现症状以来IPMT恶性转化的纵向风险。
纳入所有诊断为高度可能或经组织学证实的IPMT患者。从IPMT首次出现症状开始，采用Kaplan-Meier法计算至少出现低级别异型增生（≥LGD）、高级别异型增生（≥HGD）或浸润性癌（IC）的精算风险。通过对数秩检验比较不同性别、急性胰腺炎、肿瘤大小和MPD受累情况的风险。
纳入106例经证实（n = 76）或可能（n = 30）的IPMT患者。53例肿瘤局限于BD。从首次出现症状到随访结束的中位时间为21个月（范围0 - 241个月）。IPMT分级为≥LGD、≥HGD或IC的10年精算风险分别为67%、49%和29%。恶性转化的唯一形态学危险因素是MPD受累，MPD组≥HGD的5年精算风险为63%，而BD组为15%（P < 0.001）。
至少出现HGD或IC的纵向风险与时间相关。BD型IPMT患者的风险要低得多，这证明了非手术监测的合理性。
