Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Clin Gastroenterol Hepatol. 2017 Oct;15(10):1509-1520.e4. doi: 10.1016/j.cgh.2017.03.020. Epub 2017 Mar 22.
BACKGROUND & AIMS: It is not clear how best to manage patients with low-risk intraductal papillary mucinous neoplasms (IPMNs) of the pancreas because little is known about IPMN progression to cancer. We sought to determine the cumulative incidence of development of pancreatic cancer in persons with unresected IPMNs (particularly low-risk IPMNs).
We performed a systematic search of the MEDLINE and Embase databases through November 30, 2016 for studies reporting the cumulative incidence of pancreatic cancer in patients with unresected IPMNs or studies that provided data in sufficient detail for us to calculate cumulative incidence values. We categorized patient series as studies on low-risk IPMNs (lesions without main pancreatic duct involvement or mural nodules) or non-low-risk IPMNs. We calculated meta-analytic cumulative incidence values for pancreatic cancer at 1, 3, 5, and 10 years of follow-up by using the inverse variance method and random-effects model.
Among 1514 articles screened, we identified 10 studies of low-risk IPMNs (n = 2411) and 9 studies of non-low-risk IPMNs (n = 825). In studies of low-risk IPMNs, the meta-analytic cumulative incidence values for pancreatic cancer were 0.02% at 1 year (95% confidence interval [CI], 0.0%-0.23%; I= 0.0%), 1.40% at 3 years (95% CI, 0.58%-2.48%; I = 58.5%), 3.12% at 5 years (95% CI, 1.12%-5.90%; I = 88.0%), and 7.77% at 10 years (95% CI, 4.09%-12.39%; I = 79.8%). These values were much higher in studies of non-low-risk IPMNs; cumulative incidence values for pancreatic cancer were 1.95% at 1 year (95% CI, 0.0%-5.99%; I = 84.2%), 5.69% at 3 years (95% CI, 1.10%-12.77%; I = 89.9%), 9.77% at 5 years (95% CI, 3.04%-19.27%; I = 92.0%), and 24.68% at 10 years (95% CI, 14.87%-35.90%; I = 74.3%). The pooled cumulative incidence steadily increased linearly as the follow-up duration increased.
In a systematic review and meta-analysis, we found that low-risk IPMNs have almost 8% chance of progressing to pancreatic cancer within 10 years, and higher-risk IPMNs have almost 25% chance of progressing to cancer in 10 years; incidence values increase linearly with time. Continued long-term surveillance is therefore vital for patients with low-risk IPMNs.
目前尚不清楚如何最好地管理胰腺低风险胰管内乳头状黏液性肿瘤（IPMNs）患者，因为人们对 IPMN 进展为癌症的了解甚少。我们旨在确定未切除的 IPMN 患者（尤其是低风险 IPMN）中发生胰腺癌的累积发生率。
我们通过系统检索 MEDLINE 和 Embase 数据库，检索截至 2016 年 11 月 30 日的研究，以报告未切除的 IPMN 患者中胰腺癌的累积发生率，或提供了足够详细的数据供我们计算累积发生率值的研究。我们将患者系列分为低风险 IPMN（无主胰管受累或壁结节的病变）或非低风险 IPMN 研究。我们使用逆方差法和随机效应模型计算了 1、3、5 和 10 年随访时胰腺癌的荟萃分析累积发生率值。
在筛选的 1514 篇文章中，我们确定了 10 项低风险 IPMN（n=2411）和 9 项非低风险 IPMN（n=825）的研究。在低风险 IPMN 的研究中，胰腺癌的荟萃分析累积发生率值在 1 年时为 0.02%（95%CI，0.0%-0.23%；I=0.0%），3 年时为 1.40%（95%CI，0.58%-2.48%；I=58.5%），5 年时为 3.12%（95%CI，1.12%-5.90%；I=88.0%），10 年时为 7.77%（95%CI，4.09%-12.39%；I=79.8%）。在非低风险 IPMN 的研究中，这些值要高得多；胰腺癌的累积发生率值在 1 年时为 1.95%（95%CI，0.0%-5.99%；I=84.2%），3 年时为 5.69%（95%CI，1.10%-12.77%；I=89.9%），5 年时为 9.77%（95%CI，3.04%-19.27%；I=92.0%），10 年时为 24.68%（95%CI，14.87%-35.90%；I=74.3%）。随着随访时间的延长，累积发生率呈线性稳步上升。
在系统评价和荟萃分析中，我们发现低风险 IPMN 在 10 年内进展为胰腺癌的几率接近 8%，而高风险 IPMN 在 10 年内进展为癌症的几率接近 25%；发病率值随时间呈线性增长。因此，对低风险 IPMN 患者进行持续的长期监测至关重要。
