Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, CA, USA; Department of General and Pancreatic Surgery, The Pancreas Institute, Section of Pathology University of Verona, Verona, Italy.
Department of Pathology, Koç University Hospital and Koç University Research Center for Translational Medicine, Istanbul, Turkey.
Lancet Gastroenterol Hepatol. 2022 Dec;7(12):1141-1150. doi: 10.1016/S2468-1253(22)00235-7. Epub 2022 Aug 31.
Pancreatic intraductal papillary mucinous neoplasms (IPMNs) have gained substantial attention because they represent one of the only radiographically identifiable precursors of invasive pancreatic ductal adenocarcinoma. Although most of these neoplasms have low-grade dysplasia and will remain indolent, a subset of IPMNs will progress to invasive cancer. The role of the immune system in the progression of IPMNs is unclear, but understanding its role could reveal the mechanism of neoplastic progression and targets for immunotherapy to inhibit progression or treat invasive disease. The available evidence supports a shift in the immune composition of IPMNs during neoplastic progression. Although low-grade lesions contain a high proportion of effector T cells, high-grade IPMNs, and IPMNs with an associated invasive carcinoma lose the T-cell infiltrate and are characterised by a predominance of immunosuppressive elements. Several possible therapeutic strategies emerge from this analysis that are unique to IPMNs and its microbiome.
胰腺导管内乳头状黏液性肿瘤（IPMNs）已引起广泛关注，因为它们是唯一一种可在影像学上识别的侵袭性胰腺导管腺癌前体。尽管大多数这些肿瘤为低级别异型增生，且保持惰性，但一部分 IPMNs 会进展为浸润性癌。免疫系统在 IPMNs 进展中的作用尚不清楚，但了解其作用可能揭示肿瘤进展的机制以及免疫疗法的靶点，以抑制进展或治疗侵袭性疾病。现有证据支持在肿瘤进展过程中 IPMNs 的免疫组成发生变化。尽管低级别病变含有高比例的效应 T 细胞，但高级别 IPMNs 和伴有浸润性癌的 IPMNs 失去 T 细胞浸润，以免疫抑制性成分占优势为特征。从这一分析中出现了几种可能的治疗策略，这些策略是 IPMNs 及其微生物组所特有的。
