Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut.
Yale Waterbury Internal Medicine Program,Yale School of Medicine, New Haven, Connecticut.
Clin Gastroenterol Hepatol. 2023 Jun;21(6):1430-1446. doi: 10.1016/j.cgh.2022.04.025. Epub 2022 May 11.
BACKGROUND & AIMS: Low-risk branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) lacking worrisome features (WF) and high-risk stigmata (HRS) warrant surveillance. However, their optimal duration, especially among cysts with initial 5 years of size stability, warrants further investigation. We systematically reviewed the surveillance of low-risk BD-IPMNs and investigated the incidence of WF/HRS and advanced neoplasia, high-grade dysplasia, and pancreatic cancer during the initial (<5 years) and extended surveillance period (>5-years).
A systematic search (CRD42020117120) identified studies investigating long-term IPMN surveillance outcomes of low-risk IPMN among the Cochrane Library, Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science, from inception until July 9, 2021. The outcomes included the incidence of WF/HRS and advanced neoplasia, disease-specific mortality, and surveillance-related harm (expressed as percentage per patient-years). The meta-analysis relied on time-to-event plots and used a random-effects model.
Forty-one eligible studies underwent systematic review, and 18 studies were meta-analyzed. The pooled incidence of WF/HRS among low-risk BD-IPMNs during initial and extended surveillance was 2.2% (95% CI, 1.0%-3.7%) and 2.9% (95% CI, 1.0%-5.7%) patient-years, respectively, whereas the incidence of advanced neoplasia was 0.6% (95% CI, 0.2%-1.00%) and 1.0% (95% CI, 0.6%-1.5%) patient-years, respectively. The pooled incidence of disease-specific mortality during initial and extended surveillance was 0.3% (95% CI, 0.1%-0.6%) and 0.6% (95% CI, 0.0%-1.6%) patient-years, respectively. Among BD-IPMNs with initial size stability, extended surveillance had a WF/HRS and advanced neoplasia incidence of 1.9% (95% CI, 1.2%-2.8%) and 0.2% (95% CI, 0.1%-0.5%) patient-years, respectively.
A lower incidence of advanced neoplasia during extended surveillance among low-risk, stable-sized BD-IPMNs was a key finding of this study. However, the survival benefit of surveillance among this population warrants further exploration through high-quality studies before recommending surveillance cessation with certainty.
缺乏高危特征（WF）和高危标志物（HRS）的低危分支胰管内乳头状黏液性肿瘤（BD-IPMN）需要进行监测。然而，特别是在最初 5 年内大小稳定的囊肿中，其最佳监测持续时间仍需进一步研究。我们系统地回顾了低危 BD-IPMN 的监测情况，并调查了 WF/HRS 和高级别肿瘤、高级别异型增生和胰腺癌在初始（<5 年）和扩展监测期间（>5 年）的发生率。
通过系统检索（CRD42020117120），从 Cochrane 图书馆、Embase、Google Scholar、Ovid Medline、PubMed、Scopus 和 Web of Science 中确定了研究低危 IPMN 长期 IPMN 监测结果的研究，时间范围为从建立到 2021 年 7 月 9 日。结果包括 WF/HRS 和高级别肿瘤、疾病特异性死亡率以及监测相关危害（以每患者年的百分比表示）的发生率。荟萃分析依赖于时间事件图，并使用随机效应模型。
41 项符合条件的研究进行了系统综述，18 项研究进行了荟萃分析。低危 BD-IPMN 患者在初始和扩展监测期间 WF/HRS 的累积发生率分别为 2.2%（95%CI，1.0%-3.7%）和 2.9%（95%CI，1.0%-5.7%），而高级别肿瘤的发生率分别为 0.6%（95%CI，0.2%-1.00%）和 1.0%（95%CI，0.6%-1.5%）。初始和扩展监测期间疾病特异性死亡率的累积发生率分别为 0.3%（95%CI，0.1%-0.6%）和 0.6%（95%CI，0.0%-1.6%）。在初始大小稳定的 BD-IPMN 中，扩展监测的 WF/HRS 和高级别肿瘤发生率分别为 1.9%（95%CI，1.2%-2.8%）和 0.2%（95%CI，0.1%-0.5%）。
在低危、大小稳定的 BD-IPMN 中，扩展监测期间高级别肿瘤的发生率较低是本研究的一个关键发现。然而，在推荐确定性停止监测之前，需要通过高质量的研究进一步探讨该人群监测的生存获益。
