van Huijgevoort Nadine C M, Hoogenboom Sanne A M, Lekkerkerker Selma J, Busch Olivier R, Del Chiaro Marco, Fockens Paul, Somers Inne, Verheij Joanne, Voermans Rogier P, Besselink Marc G, van Hooft Jeanin E
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands.
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
Pancreatology. 2023 Apr;23(3):251-257. doi: 10.1016/j.pan.2023.01.011. Epub 2023 Feb 6.
Follow-up in patients with intraductal papillary mucinous neoplasm (IPMN) aims to detect advanced neoplasia (high-grade dysplasia/cancer) in an early stage. The 2015 American Gastroenterological Association (AGA), 2017 International Association of Pancreatology (IAP), and the 2018 European Study Group on Cystic tumours of the Pancreas (European) guidelines differ in their recommendations on indications for surgery. However, it remains unclear which guideline is most accurate in predicting advanced neoplasia in IPMN.
Patients who underwent surgery were extracted from a prospective database (January 2006-January 2021). In patients with IPMN, final pathology was compared with the indication for surgery according to the guidelines. ROC-curves were calculated to determine the diagnostic accuracy for each guideline.
Overall, 247 patients underwent surgery for cystic lesions. In 145 patients with IPMN, 52 had advanced neoplasia, of which the AGA guideline would have advised surgery in 14 (27%), the IAP and European guideline in 49 (94%) and 50 (96%). In 93 patients without advanced neoplasia, the AGA, IAP, and European guidelines would incorrectly have advised surgery in 8 (8.6%), 77 (83%) and 71 (76%).
The European and IAP guidelines are clearly superior in detecting advanced neoplasia in IPMN as compared to the AGA, albeit at the cost of a higher rate of unnecessary surgery. To harmonize care and to avoid confusion caused by conflicting statements, a global evidence-based guideline for PCN in collaboration with the various guidelines groups is required once the current guidelines require an update.
导管内乳头状黏液性肿瘤（IPMN）患者的随访旨在早期发现进展期肿瘤（高级别异型增生/癌）。2015年美国胃肠病学会（AGA）、2017年国际胰腺病协会（IAP）以及2018年欧洲胰腺囊性肿瘤研究组（欧洲）指南在手术适应证的建议上存在差异。然而，目前尚不清楚哪种指南在预测IPMN进展期肿瘤方面最为准确。
从一个前瞻性数据库（2006年1月至2021年1月）中提取接受手术的患者。对于IPMN患者，将最终病理结果与各指南的手术适应证进行比较。计算ROC曲线以确定各指南的诊断准确性。
总体而言，247例患者因囊性病变接受了手术。在145例IPMN患者中，52例有进展期肿瘤，其中AGA指南建议手术的有14例（27%），IAP和欧洲指南建议手术的分别有49例（94%）和50例（96%）。在93例无进展期肿瘤的患者中，AGA、IAP和欧洲指南错误建议手术的分别有8例（8.6%）、77例（83%）和71例（76%）。
与AGA相比，欧洲和IAP指南在检测IPMN进展期肿瘤方面明显更具优势，尽管代价是不必要手术的发生率更高。为了统一治疗并避免因相互矛盾的表述引起混淆，一旦当前指南需要更新，就需要与各指南小组合作制定一个基于全球证据的PCN指南。
