Tamburrino Domenico, de Pretis Nicolò, Pérez-Cuadrado-Robles Enrique, Uribarri-Gonzalez Laura, Ateeb Zeeshan, Belfiori Giulio, Maisonneuve Patrick, Capurso Gabriele, Vanella Giuseppe, Petrone Maria Chiara, Arcidiacono Paolo Giorgio, Vaalavuo Yrjo, Frulloni Luca, Dominguez-Muñoz J Enrique, Deprez Pierre H, Falconi Massimo, Del Chiaro Marco, Crippa Stefano, Laukkarinen Johanna
Pancreatic Surgery Unit, Vita-Salute University, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Milan, Italy.
Department of Gastroenterology, Pancreas Institute, University of Verona, Verona, Italy.
Br J Surg. 2022 Jun 14;109(7):617-622. doi: 10.1093/bjs/znac103.
Different surveillance strategies for patients with low-risk branch-duct (BD) intraductal papillary neoplasm (IPMN) have been described. The aim of this study was to describe the natural history of low-risk BD-IPMN, and to identify risk factors for the development of worrisome features (WF)/high-risk stigmata (HRS) and of pancreatic malignancies.
This was a multicentre retrospective study of patients with BD-IPMN who were under active surveillance between January 2006 and December 2015. Patients were eligible if they had a low-risk lesion and had a minimum follow-up of 24 months. Outcomes were development of WF/HRS or cytologically/histologically confirmed malignant IPMN.
Of 837 patients included, 168 (20 per cent) developed WF/HRS. At the end of the observation time, 132 patients (79 per cent) with WF/HRS were still under surveillance without progression to pancreatic cancer. Factors associated with the development of WF or HRS in multivariable analysis included localized nodules (versus diffuse: hazard ratio (HR) 0.43, 95 per cent c.i. 0.26 to 0.68), cyst size 15-19 mm (versus less than 15 mm: HR 1.88, 1.23 to 2.87) or at least 20 mm (versus less than 15 mm: HR 3.25, 2.30 to 4.60), main pancreatic duct size over 3 mm (versus 3 mm or less: HR 2.17, 1.41 to 3.34), and symptoms at diagnosis (versus no symptoms: HR 2.29, 1.52 to 3.45). Surveillance in an endoscopy-oriented centre was also associated with increased detection of WF or HRS (versus radiology-oriented: HR 2.46, 1.74 to 3.47).
Conservative management of patients with low-risk BD-IPMN is safe and feasible.
已描述了针对低风险分支导管（BD）内乳头状瘤（IPMN）患者的不同监测策略。本研究的目的是描述低风险BD-IPMN的自然病史，并确定出现令人担忧的特征（WF）/高风险征象（HRS）以及胰腺恶性肿瘤发生的风险因素。
这是一项对2006年1月至2015年12月期间接受主动监测的BD-IPMN患者的多中心回顾性研究。如果患者有低风险病变且至少随访24个月，则符合纳入标准。观察指标为WF/HRS的出现或经细胞学/组织学证实的恶性IPMN。
在纳入的837例患者中，168例（20%）出现了WF/HRS。在观察期结束时，132例（79%）出现WF/HRS的患者仍在接受监测，且未进展为胰腺癌。多变量分析中与WF或HRS发生相关的因素包括局限性结节（与弥漫性相比：风险比（HR）0.43，95%置信区间0.26至0.68）、囊肿大小15 - 19毫米（与小于15毫米相比：HR 1.88，1.23至2.87）或至少20毫米（与小于15毫米相比：HR 3.25，2.30至4.60）、主胰管直径超过3毫米（与3毫米或更小相比：HR 2.17，1.41至3.34）以及诊断时出现症状（与无症状相比：HR 2.29，1.52至3.45）。在内镜导向中心进行监测也与WF或HRS的检出增加相关（与放射学导向相比：HR 2.46，1.74至3.47）。
对低风险BD-IPMN患者进行保守管理是安全可行的。
