Division of Pancreatic Surgery, Università Politecnica delle Marche, Ancona, Italy.
Division of Pancreatic Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
Gut. 2017 Mar;66(3):495-506. doi: 10.1136/gutjnl-2015-310162. Epub 2016 Jan 7.
To evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians' recommendation, patient personal choice or comorbidities precluding surgery.
In this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (MD), the latter including mixed IPMNs. Univariate and multivariate analysis for overall survival (OS) and disease-specific survival (DSS) were obtained.
Of 281 patients identified, 159 (57%) had BD-IPMNs and 122 (43%) had MD-IPMNs; 50 (18%) had high-risk stigmata and 231 (82%) had worrisome features. Median follow-up was 51 months. The 5-year OS and DSS for the entire cohort were 81% and 89.9%. An invasive pancreatic malignancy developed in 34 patients (12%); 31 had invasive IPMNs (11%) and 3 had IPMN-distinct pancreatic ductal adenocarcinoma (1%). Independent predictors of poor DSS in the entire cohort were age >70 years, atypical/malignant cyst fluid cytology, jaundice and MD >15 mm. Compared with MD-IPMNs, BD-IPMNs had significantly better 5-year OS (86% vs 74.1%, p=0.002) and DSS (97% vs 81.2%, p<0.0001). Patients with worrisome features had better 5-year DSS compared with those with high-risk stigmata (96.2% vs 60.2%, p<0.0001).
In elderly patients with IPMNs that have worrisome features, the 5-year DSS is 96%, suggesting that conservative management is appropriate. By contrast, presence of high-risk stigmata is associated with a 40% risk of IPMN-related death, reinforcing that surgical resection should be offered to fit patients.
评估国际胰腺内乳头状黏液性肿瘤（IPMN）共识指南中定义的具有令人担忧特征或高危标志物的未手术治疗的胰腺导管内乳头状黏液性肿瘤（IPMN）患者的中期结果和生存预测因素。未选择手术的原因包括医生的建议、患者的个人选择或手术禁忌的合并症。
在这项回顾性多中心分析中，将 IPMN 分为分支胰管（BD）和主胰管（MD），后者包括混合性 IPMN。对总生存（OS）和疾病特异性生存（DSS）进行单因素和多因素分析。
在确定的 281 例患者中，159 例（57%）为 BD-IPMN，122 例（43%）为 MD-IPMN；50 例（18%）有高危标志物，231 例（82%）有令人担忧的特征。中位随访时间为 51 个月。整个队列的 5 年 OS 和 DSS 分别为 81%和 89.9%。34 例患者（12%）发展为侵袭性胰腺恶性肿瘤；31 例为侵袭性 IPMN（11%），3 例为 IPMN 型胰腺导管腺癌（1%）。整个队列中 DSS 不良的独立预测因素为年龄>70 岁、非典型/恶性囊液细胞学、黄疸和 MD>15mm。与 MD-IPMN 相比，BD-IPMN 的 5 年 OS（86% vs 74.1%，p=0.002）和 DSS（97% vs 81.2%，p<0.0001）显著更好。具有令人担忧特征的患者 5 年 DSS 优于具有高危标志物的患者（96.2% vs 60.2%，p<0.0001）。
在具有令人担忧特征的老年 IPMN 患者中，5 年 DSS 为 96%，提示保守治疗是合适的。相比之下，存在高危标志物与 40%的 IPMN 相关死亡风险相关，这强化了应向合适的患者提供手术切除的建议。
