Lee Brian S, Nguyen Andrew K, Tekeste Timnit F, Chang Karen, Girgis Agathon, Adeyemo Mopelola, Hanna Maryam S, Yao Janis F, Kwok Karl K, Giap Andrew Q, Hunt Gordon C, Chaya Charles T, Kao Kevin T, Attam Rajeev, Ko Albert, Pio Jose R, Tovar Stephanie, Lim Brian S
Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Pancreatology. 2021 Jan;21(1):144-154. doi: 10.1016/j.pan.2020.10.040. Epub 2020 Oct 21.
Discontinuation of branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) surveillance after 5 years of no change remains controversial. Long-term outcomes of BD-IPMN without significant changes in the first 5 years were evaluated.
We performed a multi-center retrospective analysis of patients with BD-IPMN diagnosis from 2005 to 2011 (follow-up until 2017). Significant changes were defined as pancreatic cancer (PC), pancreatectomy, high-risk stigmata (HRS), worrisome features (WF) and worrisome EUS features (WEUS).
Of 982 patients who had no significant changes, 5 (0.5%), 7 (0.7%), 99 (10.1%), 4 (0.4%) patients developed PC, HRS, WF, WEUS, respectively, post-5 years. PC and HRS/WF/WEUS incidences at 12 years were 1.0% and 29.0%, respectively. Patients that developed HRS/WF/WEUS had larger cyst size in first 5 years compared to those that did not [16 (12-23) vs. 12 (9-17) mm, p = 0.0001], cyst size of >15 mm having higher cumulative incidence of HRS/WF/WEUS. PC mortality was 0.8%; all-cause mortality was 32%. Incidence of mortality due to PC was higher in HRS/WF/WEUS group, p < 0.0001. The mortality rate at 12 years for ACCI (age-adjusted Charlson Comorbidity Index) of ≤3, 4-6, and ≥7 were 3.5%, 19.9%, and 57.6% (p < 0.0001), respectively.
Incidence of PC in patients with BD-IPMN without significant changes in first 5 years of diagnosis remains low at 1.0%. Incidence of HRS/WF/WEUS was higher at 29.0%. PC-related mortality was higher in HRS/WF/WEUS group. These risks should be weighed against patients' overall mortality (utilizing scoring systems such as ACCI) when making surveillance decision of BD-IPMN beyond 5 years.
对于分支导管内乳头状黏液性肿瘤（BD-IPMN），在5年无变化后停止监测仍存在争议。本研究评估了最初5年无显著变化的BD-IPMN的长期预后。
我们对2005年至2011年诊断为BD-IPMN的患者进行了多中心回顾性分析（随访至2017年）。显著变化定义为胰腺癌（PC）、胰腺切除术、高危特征（HRS）、可疑特征（WF）和可疑超声内镜特征（WEUS）。
在982例无显著变化的患者中，5年之后分别有5例（0.5%）、7例（0.7%）、99例（10.1%）、4例（0.4%）患者发生了PC、HRS、WF、WEUS。12年时PC和HRS/WF/WEUS的发生率分别为1.0%和29.0%。发生HRS/WF/WEUS的患者在最初5年的囊肿大小大于未发生者[16（12-23）mm对12（9-17）mm，p = 0.0001]，囊肿大小>15 mm的患者HRS/WF/WEUS的累积发生率更高。PC死亡率为0.8%；全因死亡率为32%。HRS/WF/WEUS组因PC导致的死亡率更高，p < 0.0001。年龄校正的Charlson合并症指数（ACCI）≤3、4-6和≥7的患者12年时的死亡率分别为3.5%、19.9%和57.6%（p < 0.0001）。
诊断后最初5年无显著变化的BD-IPMN患者中PC的发生率较低，为1.0%。HRS/WF/WEUS的发生率较高，为29.0%。HRS/WF/WEUS组中与PC相关的死亡率更高。在对BD-IPMN进行5年以上的监测决策时，应将这些风险与患者的总体死亡率（使用ACCI等评分系统）进行权衡。
