Pancreato-biliary Endoscopy and Endoscopic Ultrasound, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy.
Digestive and Liver Disease Unit, S Andrea Hospital, Rome, Italy.
JAMA Netw Open. 2020 Nov 2;3(11):e2022933. doi: 10.1001/jamanetworkopen.2020.22933.
Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common pancreatic preneoplastic lesions, but their surveillance is not personalized.
To investigate patient- and cyst-related factors associated with progression into worrisome features (WFs) or high-risk stigmata (HRS) categories of BD-IPMNs.
DESIGN, SETTING, AND PARTICIPANTS: Cyst- and patient-related factors of consecutive BD-IPMNs without WFs or HRS in 540 patients diagnosed from 2009 to 2018 with at least 12 months' surveillance until February 28, 2020, were registered in a 2-center ambispective cohort study in Italy. In a subgroup, the ABO blood group was studied for the first time in this setting.
Cyst-related and patients-related factors and ABO blood group.
The study outcome was the appearance of WFs or HRS according to the 2017 International Association of Pancreatology guidelines. Survival probability was calculated using Kaplan-Meier curve and risk factors identified by Cox proportional hazards regression. ABO blood group was inferred through genotypes with DNA extraction.
Of 540 patients with BD-IPMNs (median age, 66 years [interquartile range, 58.5-72.0 years]; 337 women [62.4%]) undergoing surveillance for a median of 51.5 months (interquartile range, 28-84 months) for 2758 person-years, 130 patients (24.1%) experienced progression. Probability of progression was 3.7% at 1 year, 23.4% at 5 years, and 43.3% at 10 years; 15 patients (2.8%) underwent surgery, 7 patients (1.3%) had malignant histologic findings, and 3 patients (0.56%) died of pancreatic-associated disease. Initial cyst size greater than 15 mm (hazard ratio [HR], 2.05; 95% CI, 1.44-2.91), body mass index greater than 26.4 (HR, 1.72; 95% CI, 1.19-2.50), and heavy smoking (HR, 1.81; 95% CI, 1.14-2.86) were significant independent factors associated with progression risk. The AA blood genotype was also associated with progression risk (HR, 3.49; 95% CI, 1.04-11.71) compared with the OO genotype in the investigated subgroup.
This analysis of factors associated with progression of BD-IPMNs according to recent guidelines suggests that cyst size alone is not a reliable factor for estimation of progression risk; however, along with other readily available data, size is helpful for planning personalized surveillance of BD-IPMNs.
分支导管内乳头状黏液性肿瘤（BD-IPMNs）是常见的胰腺前瘤病变，但它们的监测并未实现个体化。
研究与 BD-IPMNs 进展为令人担忧特征（WFs）或高风险标志（HRS）类别相关的患者和囊肿相关因素。
设计、设置和参与者：意大利的一个 2 中心前瞻性队列研究对 2009 年至 2018 年间诊断的 540 例无 WFs 或 HRS 的连续 BD-IPMNs 患者的囊肿和患者相关因素进行了登记，这些患者在至少 12 个月的监测后，截止到 2020 年 2 月 28 日，至少有 2758 人年进行了监测。在一个亚组中，首次在该环境中研究了 ABO 血型。
囊肿相关和患者相关因素和 ABO 血型。
研究结果是根据 2017 年国际胰腺病学会指南出现 WFs 或 HRS。使用 Kaplan-Meier 曲线和 Cox 比例风险回归识别的生存概率计算危险因素。通过 DNA 提取推断 ABO 血型的基因型。
在中位年龄为 66 岁（四分位距[IQR]，58.5-72.0 岁）的 540 例接受 BD-IPMNs 监测（中位监测时间为 51.5 个月[IQR，28-84 个月]）的患者中，中位随访时间为 540 例（IQR，28-84 个月），随访 2758 人年，130 例（24.1%）患者出现进展。1 年时的进展概率为 3.7%，5 年时为 23.4%，10 年时为 43.3%；15 例（2.8%）患者接受了手术，7 例（1.3%）患者存在恶性组织学发现，3 例（0.56%）患者死于与胰腺相关的疾病。初始囊肿大小大于 15mm（风险比[HR]，2.05；95%CI，1.44-2.91）、体重指数大于 26.4（HR，1.72；95%CI，1.19-2.50）和重度吸烟（HR，1.81；95%CI，1.14-2.86）是与进展风险相关的显著独立因素。在研究的亚组中，与 OO 基因型相比，AA 血型基因型也与进展风险相关（HR，3.49；95%CI，1.04-11.71）。
根据最新指南对与 BD-IPMNs 进展相关因素的分析表明，囊肿大小本身并不是估计进展风险的可靠因素；但是，结合其他易于获得的数据，大小有助于计划个体化的 BD-IPMNs 监测。
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