Lahat Guy, Ben Haim Mendy, Nachmany Ido, Sever Ronen, Blachar Arye, Nakache Richard, Klausner Josef M
Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
J Am Coll Surg. 2009 Sep;209(3):313-9. doi: 10.1016/j.jamcollsurg.2009.05.009. Epub 2009 Jul 9.
Pancreatic incidentaloma (PI) is an increasingly common diagnosis that has received little attention. We characterized these tumors and compared them with symptomatic pancreatic tumors (nonincidentaloma [NI]).
A retrospective database of 475 consecutive pancreatectomies that were performed from January 1995 to June 2007 at our institution was analyzed. Data for PI and NI patient cohorts were compared.
Sixty-four PIs (13.5%) and 411 NIs (86.5%) were identified; 21% of pancreatic body and tail tumors versus 9% of tumors located in the pancreatic head were incidentally diagnosed (p = 0.001). Twenty-two PIs (34%) versus 278 NIs (67%) were malignant (p < 0.0001), 38 PIs (60%) were premalignant, and the remaining 4 (6%) had little or no risk for malignant progression. Intrapapillary mucinous cystic tumor was the most common diagnosis in the PI group (23.4%, n = 15). Of these, 13.3% (n = 2) were invasive versus 40.6% (n = 15) in the NI group (p = 0.02). Likewise, pathologic features for ductal adenocarcinomas were more favorable in PI versus NI tumors. Overall, PI patients had prolonged median disease-specific survival: 145 versus 46 months (p = 0.001). Median disease-specific survival for PI versus NI patients treated for adenocarcinoma were 22 versus 19 months, respectively (p = 0.4); 5-year disease-specific survival for PI versus NI patients treated for intrapapillary mucinous cystic tumor/mucinous cystadenoma were 94% versus 68%, respectively (p = 0.07).
Operation for PI is common, and a substantial proportion of these lesions might be malignant or premalignant. Resection of these early tumors in asymptomatic individuals is associated with improved survival, as compared with patients with symptomatic disease.
胰腺偶发瘤（PI）是一种越来越常见的诊断，但受到的关注较少。我们对这些肿瘤进行了特征描述，并将它们与有症状的胰腺肿瘤（非偶发瘤[NI]）进行了比较。
分析了1995年1月至2007年6月在我们机构连续进行的475例胰腺切除术的回顾性数据库。比较了PI和NI患者队列的数据。
共识别出64例PI（13.5%）和411例NI（86.5%）；胰腺体尾部肿瘤的21%与胰头肿瘤的9%为偶然诊断（p = 0.001）。22例PI（34%）与278例NI（67%）为恶性（p < 0.0001），38例PI（60%）为癌前病变，其余4例（6%）恶性进展风险很小或没有风险。导管内乳头状黏液性囊性肿瘤是PI组最常见的诊断（23.4%，n = 15）。其中，13.3%（n = 2）为浸润性，而NI组为40.6%（n = 15）（p = 0.02）。同样，PI肿瘤中导管腺癌的病理特征比NI肿瘤更有利。总体而言，PI患者的疾病特异性中位生存期延长：145个月对46个月（p = 0.001）。PI和NI患者腺癌治疗的疾病特异性中位生存期分别为22个月和19个月（p = 0.4）；PI和NI患者导管内乳头状黏液性囊性肿瘤/黏液性囊腺瘤治疗的5年疾病特异性生存率分别为94%和68%（p = 0.07）。
PI的手术很常见，这些病变中有很大一部分可能是恶性或癌前病变。与有症状疾病的患者相比，无症状个体中这些早期肿瘤的切除与生存率提高相关。
