接受胰腺切除术治疗的伴有高级别异型增生的导管内乳头状黏液性肿瘤患者的复发模式和长期预后：对监测及未来管理指南的启示

Patterns of recurrence and long-term outcomes in patients who underwent pancreatectomy for intraductal papillary mucinous neoplasms with high grade dysplasia: implications for surveillance and future management guidelines.

作者信息

Blackham Aaron U, Doepker Matthew P, Centeno Barbara A, Springett Gregory, Pimiento Jose M, Malafa Mokenge, Hodul Pamela J

机构信息

Department of Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, 12901 Magnolia Drive, Tampa, FL 33612, USA.

Department of Anatomic Pathology, Moffitt Cancer Center and Research Institute, 12901 Magnolia Drive, Tampa, FL 33612, USA.

出版信息

HPB (Oxford). 2017 Jul;19(7):603-610. doi: 10.1016/j.hpb.2017.03.007. Epub 2017 May 9.

DOI:10.1016/j.hpb.2017.03.007

PMID:28495434

Abstract

BACKGROUND

While intraductal papillary mucinous neoplasms (IPMNs) with high-grade dysplasia (HGD) are thought to represent non-invasive, high-risk lesions, its natural history following resection is unknown.

METHODS

A retrospective review of HGD-IPMN patients (1999-2015) was performed. Recurrence patterns and clinical outcomes following pancreatectomy were analyzed and the indications for surgery were explored based on current guidelines.

RESULTS

HGD was diagnosed in 100 of 314 patients (32%) following pancreatectomy for IPMN. IPMNs were classified as main duct, branch duct, or mixed in 15, 58 and 27 patients, respectively. Following resection, 25 patients had low-risk residual disease in the remnant pancreas. With a median follow-up of 35 months (range 1-129), 9 patients developed progressive or recurrent disease, 4 of whom underwent additional pancreatectomy. Three patients developed invasive adenocarcinoma. Median time to recurrence was 15 months (range 7-72). Based on the management algorithm from the international consensus guidelines, resection was indicated in 76 patients (76%). Other indications for surgery included mixed-duct IPMN(13), increased cyst size(7) and other(4).

CONCLUSION

The prognosis of HGD-IPMN following resection is good; however, HGD may be a marker for developing IPMN recurrence or adenocarcinoma. Current guidelines regarding surgical indications for IPMN can miss a significant number of patients with HGD.

摘要

背景

虽然伴有高级别异型增生（HGD）的导管内乳头状黏液性肿瘤（IPMN）被认为是无创的高风险病变，但其切除术后的自然病程尚不清楚。

方法

对HGD-IPMN患者（1999 - 2015年）进行回顾性研究。分析胰腺切除术后的复发模式和临床结果，并根据现行指南探讨手术指征。

结果

在314例因IPMN行胰腺切除术的患者中，100例（32%）被诊断为HGD。IPMN分别被分类为主胰管型、分支胰管型或混合型，患者数分别为15例、58例和27例。切除术后，25例患者在残余胰腺中有低风险残留病灶。中位随访时间为35个月（范围1 - 129个月），9例患者出现疾病进展或复发，其中4例接受了再次胰腺切除术。3例患者发生浸润性腺癌。复发的中位时间为15个月（范围7 - 72个月）。根据国际共识指南的管理算法，76例患者（76%）有手术指征。其他手术指征包括混合型IPMN（13例）、囊肿大小增加（7例）和其他（4例）。