Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2013 Oct;20(11):3643-7. doi: 10.1245/s10434-013-3042-2. Epub 2013 Jun 8.
Pancreatic intraepithelial neoplasia (PanIN) is a presumed precursor of pancreatic ductal adenocarcinoma (PDAC). We assessed the relationship between incidental PanIN after resection of non-adenocarcinoma lesions and the development of metachronous PDAC in the remnant.
We retrospectively reviewed the clinicopathologic data of patients who underwent pancreatectomy for non-PDAC from January 2000 to January 2010. Intraductal papillary mucinous lesions were excluded. All available postoperative imaging and clinical follow-up data were reviewed; the risk of developing PDAC was assessed in patients with a minimum follow-up time of 6 months and with imaging studies available for review.
A total of 584 patients were analyzed. Median age was 59 years (range 10-85 years), and 338 (58 %) were female. The most common lesions for which resection was performed were serous cystic neoplasms (17 %), pancreatic neuroendocrine tumors (38 %), metastatic tumors (9 %), and mucinous cystic neoplasms (7 %). PanIN was identified in 153 (26 %) patients. The majority of these patients had PanIN-1 or -2 (50 and 41 %, respectively), whereas 13 (8 %) had PanIN-3. Of the 506 (87 %) patients with adequate follow-up (median 3.7 years, range 0.5-12.6 years), 1 patient (0.2 %) with PanIN identified at the time of initial resection developed cancer in the remnant. This occurred 4.4 years after a distal pancreatectomy in the setting of PanIN-1B. No patient with PanIN-3 developed cancer during follow-up.
PanIN was identified in 26 % of patients who underwent resection for histopathology other than PDAC. The presence of PanIN of any grade did not result in an appreciable cancer risk in the pancreatic remnant after short-term follow-up.
胰腺上皮内瘤变（PanIN）被认为是胰腺导管腺癌（PDAC）的前体。我们评估了非腺癌病变切除后偶然发现的 PanIN 与残胰内同时性 PDAC 发展之间的关系。
我们回顾性分析了 2000 年 1 月至 2010 年 1 月期间因非 PDAC 而行胰切除术的患者的临床病理资料。排除了导管内乳头状黏液性病变。回顾了所有可获得的术后影像学和临床随访资料；对随访时间至少 6 个月且有影像学检查可评估的患者，评估其发生 PDAC 的风险。
共分析了 584 例患者。中位年龄为 59 岁（范围 10-85 岁），338 例（58%）为女性。切除的最常见病变是浆液性囊腺瘤（17%）、胰腺神经内分泌肿瘤（38%）、转移性肿瘤（9%）和黏液性囊腺瘤（7%）。在 153 例（26%）患者中发现了 PanIN。这些患者大多数为 PanIN-1 或 -2（分别为 50%和 41%），而 13 例（8%）为 PanIN-3。在 506 例（87%）有足够随访的患者中（中位随访时间为 3.7 年，范围 0.5-12.6 年），1 例（0.2%）在初次切除时发现 PanIN 的患者在残胰中发生了癌症。这发生在 1 例存在 PanIN-1B 的远端胰腺切除术后 4.4 年。在随访期间，没有 PanIN-3 患者发生癌症。
在因非 PDAC 而行病理检查的患者中，有 26%的患者发现了 PanIN。在短期随访中，任何级别的 PanIN 均不会导致残胰发生明显的癌症风险。
