Department of Surgery, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.
Pancreas Translational &Clinical Research Center, Division of Pancreatic Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
Am J Gastroenterol. 2017 Jul;112(7):1153-1161. doi: 10.1038/ajg.2017.43. Epub 2017 Feb 28.
To evaluate the results of active surveillance beyond 5 years in patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) without worrisome features (WF) and high-risk stigmata (HRS) undergoing non-operative management.
Patients with a minimum follow-up of 5 years who underwent surveillance with at least yearly magnetic resonance imaging were included. New onset of and predictors of WF/HRS during follow-up as well as long-term survival were analyzed.
In all, 144 patients were followed for a median of 84 months. At diagnosis multifocal BD-IPMNs were found in 53% of cases and mean size of the largest cyst was 15.5 mm. Changes during follow-up were observed in 69 patients (48%). New onset of WF/HRS were observed in 26 patients (18%) but the rate of HRS was only 4%. WF and HRS developed after a median follow-up of 71 and 77.5 months from diagnosis, respectively, and without previous changes in 19/26 patients. Independent predictors of WF/HRS development were size at diagnosis>15 mm, increase in number of lesions, main pancreatic duct growth rate ≥0.2 mm/year, cyst growth rate >1 mm/year. Overall, the rate of pancreatic invasive malignancy was 2% and the 12-year disease-specific survival was 98.6%.
Long-term nonoperative management is safe for BD-IPMNs without WF and HRS. Discontinuation of surveillance cannot be recommended since one out of six patients developed WF/HRS far beyond 5 years of surveillance and without previous relevant modifications. An intensification of follow-up should be considered after 5 years.
评估无高危特征（WF）和高风险影像学特征（HRS）的分支胰管型胰内黏液性肿瘤（BD-IPMN）患者接受非手术治疗后超过 5 年的主动监测结果。
纳入至少随访 5 年且每年至少接受一次磁共振成像检查的患者。分析随访期间 WF/HRS 的新发及预测因素以及长期生存情况。
共有 144 例患者接受了中位时间为 84 个月的随访。诊断时，53%的患者有多发性 BD-IPMN，最大囊肿的平均直径为 15.5mm。69 例（48%）患者在随访期间发生了变化。26 例（18%）患者出现 WF/HRS，但 HRS 的发生率仅为 4%。WF 和 HRS 分别在诊断后 71 和 77.5 个月时出现，且 19/26 例患者在此之前无变化。WF/HRS 发生的独立预测因素包括诊断时的大小>15mm、病变数量增加、主胰管生长速度≥0.2mm/年、囊肿生长速度>1mm/年。总体而言，胰腺侵袭性恶性肿瘤的发生率为 2%，12 年疾病特异性生存率为 98.6%。
对于无 WF 和 HRS 的 BD-IPMN，长期非手术治疗是安全的。不能推荐停止监测，因为每 6 例患者中就有 1 例在监测超过 5 年后出现 WF/HRS，且在此之前无相关变化。在 5 年后应考虑加强随访。
