Valente Roberto, Crippa Stefano, Arnelo Urban, Vanella Giuseppe, Zerboni Giulia, Zarantonello Laura, Fogliati Alessandro, Arcidiacono Paolo Giorgio, Vujasinovic Miroslav, Lohr Johannes Matthias, Falconi Massimo, Capurso Gabriele, Del Chiaro Marco
Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Perioperative Sciences, Surgery, Umeå University Hospital, Umeå, Sweden; Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Department of Surgical Oncology, Anschutz Medical Campus, University of Colorado, Denver, USA.
Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, IRCCS, Milan, Italy.
Pancreatology. 2022 May;22(4):516-524. doi: 10.1016/j.pan.2022.03.020. Epub 2022 Mar 31.
Chemoprevention's ability to slow down or prevent the progression of BD-IPMNs is extremely appealing. Aspirin (ASA), Ace Inhibitors/Angiotensin Receptor Blockers (ACEIs/ARBs) and Statins (STATs) are frequently prescribed drugs with a possible beneficial effect on different cancer types. Their effect on IPMNs is largely unknown.
To evaluate the association between the use of ASA, ACEIs/ARBs and STATs and the risk of progression of BD-IPMNs in follow-up.
multicenter, retrospective cohort study on patients with presumed BD-IPMNs without relative or absolute indication for surgery. Pharmacological exposures and risk factors were collected. We identified clinically relevant progression (occurrence of radiological absolute or relative indication for surgery) and any progression (occurrence of clinically relevant progression OR any dimension increase OR the occurrence of new cysts).
Overall 594 patients were included. ACEIs were associated with a lower occurrence of any progression (HR = 0.70; 95% CI 0.49-0.98, p = 0.04) and clinically relevant progression, HR = 0.42 (95% CI 0.20-0.88; p = 0.02). No significant effect was shown for factors associated with the occurrence of pancreas cancer such as smoking, alcohol consumption and 1st degree family history of pancreas cancer. Among pharmacological exposures, no convincing effect was shown for the chronic use of ASA, ARB and STAT.
ACEIs might have an effect in slowing the progression of BD-IPMNs. ASA, STAT and ARBs show no convincing effect on the progression of BD-IPMNs. Further, prospective, and long-term multicenter studies are needed to verify such association and to define the potential underlying mechanisms.
化学预防减缓或阻止胆管内乳头状黏液性肿瘤（BD-IPMNs）进展的能力极具吸引力。阿司匹林（ASA）、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEIs/ARBs）和他汀类药物（STATs）是常用药物，对不同类型癌症可能具有有益作用。它们对IPMNs的影响在很大程度上尚不清楚。
评估ASA、ACEIs/ARBs和STATs的使用与随访期间BD-IPMNs进展风险之间的关联。
对无手术相对或绝对指征的疑似BD-IPMNs患者进行多中心回顾性队列研究。收集药物暴露和风险因素。我们确定了临床相关进展（出现手术的放射学绝对或相对指征）和任何进展（出现临床相关进展或任何尺寸增加或出现新囊肿）。
共纳入594例患者。ACEIs与任何进展的发生率较低相关（风险比[HR]=0.70；95%置信区间[CI]0.49-0.98，p=0.04）以及临床相关进展相关，HR=0.42（95%CI 0.20-0.88；p=0.02）。与胰腺癌发生相关的因素，如吸烟、饮酒和胰腺癌一级家族史，未显示出显著影响。在药物暴露中，长期使用ASA、ARB和STAT未显示出令人信服的效果。
ACEIs可能对减缓BD-IPMNs的进展有作用。ASA、STAT和ARBs对BD-IPMNs的进展未显示出令人信服的效果。此外，需要进一步的前瞻性长期多中心研究来验证这种关联并确定潜在的机制。
