Balduzzi A, Marchegiani G, Pollini T, Biancotto M, Caravati A, Stigliani E, Burelli A, Bassi C, Salvia R
Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Italy.
Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Italy.
Pancreatology. 2021 May 5. doi: 10.1016/j.pan.2021.04.009.
The vast majority of presumed branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas are referred to a surveillance program due to the relatively low risk of malignancy. We aim to evaluate all available data from observational studies focused on the risks of BD-IPMN progression and malignancy to provide vital insights into its management in clinical practice.
A comprehensive search was conducted at PubMed, Cochrane, Web of Science and Embase for observational studies published before January 1st, 2020. The progression of BD-IPMN was defined as the development of worrisome features (WFs) or high-risk stigmata (HRS) during surveillance. Overall malignancy was defined as all malignancies, such as malignant IPMN, concomitant pancreatic ductal adenocarcinoma (PDAC) and other malignancies, including BD-IPMN with high-grade sec. Baltimore consensus 2015 or BD-IPMN with high-grade dysplasia (carcinoma in situ) sec. WHO 2010. A meta-analysis was performed to investigate the presence of a mural nodule as a possible predictor of malignancy.
Twenty-four studies were included, with a total of 8941 patients with a presumed BD-IPMN. The progression rate was 20.2%, and 11.8% underwent surgery, 29.5% of whom showed malignancy at the final pathology. Of those, 78% had malignant IPMNs, and 22% had concomitant pancreatic cancer. Overall, 0.5% had distant metastasis. The meta-analysis showed that the risk of malignancy in the presence of a mural nodule >5 mm had a RR of 5.457 (95% CI 1.404-21.353), while a nonenhancing mural nodule or an enhancing mural nodule < 5 mm had a RR of 5.286 (95% CI 1.805-15.481) of harboring malignancy.
Most presumed BD-IPMNs entering surveillance do not become malignant. Of those submitted to surgery, concomitant PDAC adds to the overall risk of detecting malignancy.
由于恶性风险相对较低，绝大多数疑似胰腺分支导管内乳头状黏液性肿瘤（BD-IPMN）患者会进入监测程序。我们旨在评估来自观察性研究的所有可用数据，这些研究聚焦于BD-IPMN进展和恶性风险，以便为其临床管理提供重要见解。
在PubMed、Cochrane、Web of Science和Embase上对2020年1月1日前发表的观察性研究进行全面检索。BD-IPMN的进展定义为在监测期间出现可疑特征（WFs）或高危征象（HRS）。总体恶性肿瘤定义为所有恶性肿瘤，如恶性IPMN、伴发的胰腺导管腺癌（PDAC）和其他恶性肿瘤，包括2015年巴尔的摩共识定义的高级别BD-IPMN或2010年世界卫生组织定义的高级别异型增生（原位癌）的BD-IPMN。进行荟萃分析以研究壁结节作为恶性肿瘤可能预测指标的存在情况。
纳入24项研究，共有8941例疑似BD-IPMN患者。进展率为20.2%，11.8%的患者接受了手术，其中29.5%在最终病理检查时显示为恶性。其中，78%患有恶性IPMN，22%患有伴发胰腺癌。总体而言，0.5%有远处转移。荟萃分析表明，壁结节>5 mm时发生恶性肿瘤的风险RR为5.457（95%CI 1.404 - 21.353），而无强化壁结节或强化壁结节<5 mm时发生恶性肿瘤的风险RR为5.286（95%CI 1.805 - 15.481）。
大多数进入监测的疑似BD-IPMN不会恶变。在接受手术的患者中，伴发的PDAC增加了检测到恶性肿瘤的总体风险。
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