Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Ann Surg. 2024 Jan 1;279(1):119-124. doi: 10.1097/SLA.0000000000005922. Epub 2023 May 22.
To identify risk factors associated with the progression of pancreatic cysts in patients undergoing surveillance.
Previous studies of intraductal papillary mucinous neoplasms (IPMNs) rely on surgical series to determine malignancy risk and have inconsistently identified characteristics associated with IPMN progression.
We conducted a retrospective review of 2197 patients presenting with imaging concerning for IPMN from 2010 to 2019 at a single institution. Cyst progression was defined as resection or pancreatic cancer development.
The median follow-up time was 84 months from the presentation. The median age was 66 years, and 62% were female. Ten percent had a first-degree relative with pancreatic cancer, and 3.2% had a germline mutation or genetic syndrome associated with an increased risk of pancreatic ductal adenocarcinoma (PDAC). Cumulative incidence of progression was 17.8% and 20.0% at 12 and 60 months postpresentation, respectively. Surgical pathology for 417 resected cases showed noninvasive IPMN in 39% of cases and PDAC with or without associated IPMN in 20%. Only 18 patients developed PDAC after 6 months of surveillance (0.8%). On multivariable analysis, symptomatic disease [hazard ratio (HR)=1.58; 95% CI: 1.25-2.01], current smoker status (HR=1.58; 95% CI: 1.16-2.15), cyst size (HR=1.26; 95% CI: 1.20-1.33), main duct dilation (HR=3.17; 95% CI: 2.44-4.11), and solid components (HR=1.89; 95% CI: 1.34-2.66) were associated with progression.
Worrisome features on imaging at presentation, current smoker status, and symptomatic presentation are associated with IPMN progression. Most patients progressed within the first year of presentation to Memorial Sloan Kettering Cancer Center (MSKCC). Further investigation is necessary to develop personalized cyst surveillance strategies.
确定接受监测的胰腺囊肿患者进展的相关风险因素。
先前对胰管内乳头状黏液性肿瘤（IPMN）的研究依赖于手术系列来确定恶性肿瘤风险，并且不一致地确定了与 IPMN 进展相关的特征。
我们对 2010 年至 2019 年期间在一家机构因影像学检查怀疑 IPMN 而就诊的 2197 例患者进行了回顾性研究。囊肿进展定义为切除或胰腺癌发展。
中位随访时间为从就诊到出现症状后的 84 个月。中位年龄为 66 岁，62%为女性。10%的患者有一级亲属患有胰腺癌，3.2%的患者存在与胰腺导管腺癌（PDAC）风险增加相关的种系突变或遗传综合征。分别在 12 个月和 60 个月时，进展的累积发生率分别为 17.8%和 20.0%。对 417 例切除病例的手术病理检查显示，非浸润性 IPMN 占 39%，PDAC 伴或不伴相关 IPMN 占 20%。仅 18 例患者在监测 6 个月后发生 PDAC（0.8%）。多变量分析显示，症状性疾病（风险比 [HR] = 1.58；95%CI：1.25-2.01）、当前吸烟状况（HR = 1.58；95%CI：1.16-2.15）、囊肿大小（HR = 1.26；95%CI：1.20-1.33）、主胰管扩张（HR = 3.17；95%CI：2.44-4.11）和实性成分（HR = 1.89；95%CI：1.34-2.66）与进展相关。
在就诊时出现影像学上令人担忧的特征、当前吸烟状况和症状性表现与 IPMN 进展相关。大多数患者在就诊至 Memorial Sloan Kettering Cancer Center（MSKCC）的一年内出现进展。需要进一步研究以制定个性化的囊肿监测策略。
