Lawrence Sharon A, Attiyeh Marc A, Seier Kenneth, Gönen Mithat, Schattner Mark, Haviland Dana L, Balachandran Vinod P, Kingham T Peter, D'Angelica Michael I, DeMatteo Ronald P, Brennan Murray F, Jarnagin William R, Allen Peter J
*Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY †Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY ‡Division of Gastroenterology, Memorial Sloan Kettering Cancer Center, New York, NY.
Ann Surg. 2017 Sep;266(3):536-544. doi: 10.1097/SLA.0000000000002371.
In 2015, the American Gastroenterological Association recommended the discontinuation of radiographic surveillance after 5 years for patients with stable pancreatic cysts. The current study evaluated the yield of continued surveillance of pancreatic cysts up to and after 5 years of follow up.
A prospectively maintained registry of patients evaluated for pancreatic cysts was queried (1995-2016). Patients who initially underwent radiographic surveillance were divided into those with <5 years and ≥5 years of follow up. Analyses for the presence of cyst growth (>5 mm increase in diameter), cross-over to resection, and development of carcinoma were performed.
A total of 3024 patients were identified, with 2472 (82%) undergoing initial surveillance. The ≥5 year group (n = 596) experienced a greater frequency of cyst growth (44% vs. 20%; P < 0.0001), a lower rate of cross-over to resection (8% vs 11%; P = 0.02), and a similar frequency of progression to carcinoma (2% vs 3%; P = 0.07) compared with the <5 year group (n = 1876). Within the ≥5 year group, 412 patients (69%) had demonstrated radiographic stability at the 5-year time point. This subgroup, when compared with the <5 year group, experienced similar rates of cyst growth (19% vs. 20%; P= 0.95) and lower rates of cross-over to resection (5% vs 11%; P< 0.0001) and development of carcinoma (1% vs 3%; P= 0.008). The observed rate of developing cancer in the group that was stable at the 5-year time point was 31.3 per 100,000 per year, whereas the expected national age-adjusted incidence rate for this same group was 7.04 per 100,000 per year.
Cyst size stability at the 5-year time point did not preclude future growth, cross-over to resection, or carcinoma development. Patients who were stable at 5 years had a nearly 3-fold higher risk of developing cancer compared with the general population and should continue long-term surveillance.
2015年，美国胃肠病学会建议，对于胰腺囊肿稳定的患者，5年后停止影像学监测。本研究评估了长达5年及5年后继续监测胰腺囊肿的获益情况。
查询了一个前瞻性维护的胰腺囊肿评估患者登记册（1995 - 2016年）。最初接受影像学监测的患者被分为随访时间<5年和≥5年两组。对囊肿生长（直径增加>5毫米）、转为手术切除以及癌变情况进行分析。
共识别出3024例患者，其中2472例（82%）接受了初始监测。与随访时间<5年的组（n = 1876）相比，随访时间≥5年的组（n = 596）囊肿生长频率更高（44%对20%；P < 0.0001），转为手术切除的比例更低（8%对11%；P = 0.02），癌变进展频率相似（2%对3%；P = 0.07）。在随访时间≥5年的组中，412例患者（69%）在5年时间点显示影像学稳定。与随访时间<5年的组相比，该亚组囊肿生长率相似（19%对20%；P = 0.95），转为手术切除的比例更低（5%对11%；P < 0.0001），癌变发生率更低（1%对3%；P = 0.008）。在5年时间点稳定的组中，观察到的每年癌症发生率为每10万人31.3例，而该组预期的全国年龄调整发病率为每10万人7.04例。
5年时间点的囊肿大小稳定并不排除未来生长、转为手术切除或癌变。5年时稳定的患者发生癌症的风险比一般人群高近3倍，应继续进行长期监测。
