Tada Minoru, Kawabe Takao, Arizumi Masatoshi, Togawa Osamu, Matsubara Saburo, Yamamoto Natsuyo, Nakai Yosuke, Sasahira Naoki, Hirano Kenji, Tsujino Takeshi, Tateishi Keisuke, Isayama Hiroyuki, Toda Nobuo, Yoshida Haruhiko, Omata Masao
Department of Gastroenterology, University of Tokyo, Tokyo, Japan.
Clin Gastroenterol Hepatol. 2006 Oct;4(10):1265-70. doi: 10.1016/j.cgh.2006.07.013. Epub 2006 Sep 18.
BACKGROUND & AIMS: K-ras mutation is frequently detected in pancreatic juice of patients with pancreatic small cystic lesions, as well as those with pancreatic cancer. Those cystic lesions are often found by chance with modern radiologic imaging modalities. In this study, we prospectively examined the prognosis of patients with pancreatic cystic lesions, focusing on pancreatic cancer development.
A total of 197 patients with pancreatic cystic lesions, 80 with intraductal papillary mucinous neoplasm (IPMN) and 117 with non-IPMN cysts, were followed up for 3.8 years on average. Blood tests and imaging diagnosis were performed twice a year. The observed incidence of pancreatic cancer was compared with the expected incidence calculated on the basis of age- and gender-matched mortality of pancreatic cancer in the general Japanese population.
Pancreatic cancer developed in 7 patients during the observation period (0.95% per year), infiltrating ductal carcinoma in 5 and intraductal papillary mucinous carcinoma in 2. Three of the ductal cancer cases had pancreatic non-IPMN cyst as preexisting lesion. At least 2 of the carcinomas arose in regions remote from preexisting lesions. The observed incidence of pancreatic cancer was 22.5 times higher (95% confidence interval, 11.0-45.3) than expected mortality from this cancer among general population.
Patients with pancreatic cystic lesions are at a considerably high risk for pancreatic cancer, with a standardized incidence rate of 22.5. Cancer might develop in regions remote from the preexisting cystic lesion, suggesting diffuse pathologic changes predisposing to malignant transformation in the entire pancreas harboring cystic lesions.
在胰腺小囊性病变患者以及胰腺癌患者的胰液中经常检测到K-ras突变。这些囊性病变常通过现代放射影像学手段偶然发现。在本研究中，我们前瞻性地研究了胰腺囊性病变患者的预后，重点关注胰腺癌的发生情况。
总共197例胰腺囊性病变患者，80例为导管内乳头状黏液性肿瘤（IPMN），117例为非IPMN囊肿，平均随访3.8年。每年进行两次血液检查和影像诊断。将观察到的胰腺癌发病率与根据日本普通人群中胰腺癌的年龄和性别匹配死亡率计算出的预期发病率进行比较。
在观察期内7例患者发生了胰腺癌（每年0.95%），其中5例为浸润性导管癌，2例为导管内乳头状黏液癌。3例导管癌病例以胰腺非IPMN囊肿为原有病变。至少2例癌发生在远离原有病变的区域。观察到的胰腺癌发病率比普通人群中该癌症的预期死亡率高22.5倍（95%置信区间，11.0 - 45.3）。
胰腺囊性病变患者患胰腺癌的风险相当高，标准化发病率为22.5。癌症可能在远离原有囊性病变的区域发生，提示在整个存在囊性病变的胰腺中存在易发生恶性转化的弥漫性病理改变。
