Lawson Robert D, Hunt Gordon C, Giap Andrew Q, Krinsky Mary L, Slezak Jeff, Tang Raymond S, Gonzalez Ingrid, Kwong Wilson T, Fehmi Syed A, Savides Thomas J
Department of Gastroenterology, Naval Medical Center, San Diego, California (Robert D. Lawson).
Department of Gastroenterology, Kaiser Permanente, San Diego, California (Gordon C. Hunt).
Ann Gastroenterol. 2015 Oct-Dec;28(4):487-94.
The risk of developing pancreatic cancer is uncertain in patients with clinically suspected branch duct intraductal papillary mucinous neoplasm (BD-IPMN) based on the "high-risk stigmata" or "worrisome features" criteria proposed in the 2012 international consensus guidelines ("Fukuoka criteria").
Retrospective case series involving patients referred for endoscopic ultrasound (EUS) of indeterminate pancreatic cysts with clinical and EUS features consistent with BD-IPMN. Rates of pancreatic cancer occurring at any location in the pancreas were compared between groups of patients with one or more Fukuoka criteria ("Highest-Risk Group", HRG) and those without these criteria ("Lowest-Risk Group", LRG).
After exclusions, 661 patients comprised the final cohort (250 HRG and 411 LRG patients), 62% female with an average age of 67 years and 4 years of follow up. Pancreatic cancer, primarily adenocarcinoma, occurred in 60 patients (59 HRG, 1 LRG). Prevalent cancers diagnosed during EUS, immediate surgery, or first year of follow up were found in 48/661 (7.3%) of cohort and exclusively in HRG (33/77, 42.3%). Using Kaplan-Meier method, the cumulative incidence of cancer at 7 years was 28% in HRG and 1.2% in LRG patients (P<0.001).
This study supports using Fukuoka criteria to stratify the immediate and long-term risks of pancreatic cancer in presumptive BD-IPMN. The risk of pancreatic cancer was highest during the first year and occurred exclusively in those with "high-risk stigmata" or "worrisome features" criteria. After the first year all BD-IPMN continued to have a low but persistent cancer risk.
根据2012年国际共识指南（“福冈标准”）中提出的“高危特征”或“可疑特征”标准，临床疑似分支导管内乳头状黏液性肿瘤（BD-IPMN）患者发生胰腺癌的风险尚不确定。
回顾性病例系列研究，纳入因胰腺囊肿性质不明而接受内镜超声（EUS）检查、临床和EUS特征符合BD-IPMN的患者。比较有一项或多项福冈标准的患者组（“最高风险组”，HRG）和无这些标准的患者组（“最低风险组”，LRG）胰腺任何部位发生胰腺癌的比率。
排除后，最终队列包括661例患者（250例HRG患者和411例LRG患者），62%为女性，平均年龄67岁，随访4年。60例患者发生胰腺癌，主要为腺癌（59例HRG患者，1例LRG患者）。在EUS检查、即刻手术或随访第一年诊断出的现患癌在队列中的发生率为48/661（7.3%），且仅见于HRG（33/77，42.3%）。采用Kaplan-Meier法，HRG患者7年时癌症累积发生率为28%，LRG患者为1.2%（P<0.001）。
本研究支持使用福冈标准对疑似BD-IPMN患者胰腺癌的近期和长期风险进行分层。胰腺癌风险在第一年最高，且仅发生于有“高危特征”或“可疑特征”标准的患者。第一年之后，所有BD-IPMN患者的癌症风险虽低但持续存在。
