高危人群的胰腺癌监测。
Surveillance for pancreatic cancer in high-risk individuals.
机构信息
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
出版信息
BJS Open. 2019 Jul 2;3(5):656-665. doi: 10.1002/bjs5.50180. eCollection 2019 Oct.
BACKGROUND
Surveillance of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) and its precursors might lead to better outcomes. The aim of this study was to determine the prevalence and outcomes of PDAC and high-risk neoplastic precursor lesions among such patients participating in surveillance programmes.
METHODS
A multicentre study was conducted through the International CAncer of the Pancreas Screening (CAPS) Consortium Registry to identify high-risk individuals who had undergone pancreatic resection or progressed to advanced PDAC while under surveillance. High-risk neoplastic precursor lesions were defined as: pancreatic intraepithelial neoplasia (PanIN) 3, intraductal papillary mucinous neoplasia (IPMN) with high-grade dysplasia, and pancreatic neuroendocrine tumours at least 2 cm in diameter.
RESULTS
Of 76 high-risk individuals identified in 11 surveillance programmes, 71 had undergone surgery and five had been diagnosed with inoperable PDAC. Of the 71 patients who underwent resection, 32 (45 per cent) had PDAC or a high-risk precursor (19 PDAC, 4 main-duct IPMN, 4 branch-duct IPMN, 5 PanIN-3); the other 39 patients had lesions thought to be associated with a lower risk of neoplastic progression. Age at least 65 years, female sex, carriage of a gene mutation and location of a lesion in the head/uncinate region were associated with high-risk precursor lesions or PDAC. The survival of high-risk individuals with low-risk neoplastic lesions did not differ from that in those with high-risk precursor lesions. Survival was worse among patients with PDAC. There was no surgery-related mortality.
CONCLUSION
A high proportion of high-risk individuals who had surgical resection for screening- or surveillance-detected pancreatic lesions had a high-risk neoplastic precursor lesion or PDAC at the time of surgery. Survival was better in high-risk individuals who had either low- or high-risk neoplastic precursor lesions compared with that in patients who developed PDAC.
背景
对胰腺导管腺癌 (PDAC) 及其前体高危个体进行监测可能会改善预后。本研究旨在确定参与监测计划的此类患者中 PDAC 和高危肿瘤前病变的患病率和结局。
方法
通过国际胰腺癌筛查 (CAPS) 联盟注册中心进行了一项多中心研究，以确定接受过胰腺切除术或在监测期间进展为晚期 PDAC 的高危个体。高危肿瘤前病变定义为：胰腺上皮内瘤变 (PanIN) 3、高级别异型增生的胰管内乳头状黏液性肿瘤 (IPMN) 和至少 2cm 直径的胰腺神经内分泌肿瘤。
结果
在 11 个监测计划中确定了 76 名高危个体，其中 71 名接受了手术，5 名被诊断为无法手术的 PDAC。在接受切除术的 71 名患者中，32 名 (45%) 患有 PDAC 或高危前体 (19 例 PDAC、4 例主胰管 IPMN、4 例分支胰管 IPMN、5 例 PanIN-3)；其余 39 例患者的病变被认为与肿瘤进展的风险较低相关。年龄≥65 岁、女性、携带基因突变和病变位于头部/钩突区域与高危前体病变或 PDAC 相关。低危肿瘤病变的高危个体的生存率与高危前体病变的高危个体无差异。PDAC 患者的生存率更差。无手术相关死亡。
结论
在因筛查或监测发现胰腺病变而行手术切除的高危个体中，相当一部分人在手术时存在高危肿瘤前病变或 PDAC。与发生 PDAC 的患者相比，具有低危或高危肿瘤前病变的高危个体的生存率更好。
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