Department of General and Pancreatic Surgery, The Pancreas Institute, Verona University Hospital, Verona, Italy; Hepatopancreatobiliary and Liver Transplant Surgery, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy.
Department of General and Pancreatic Surgery, The Pancreas Institute, Verona University Hospital, Verona, Italy.
Gastroenterology. 2023 Oct;165(4):1016-1024.e5. doi: 10.1053/j.gastro.2023.06.022. Epub 2023 Jul 4.
BACKGROUND & AIMS: Currently, most patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMN) are offered indefinite surveillance, resulting in health care costs with questionable benefits regarding cancer prevention. This study sought to identify patients in whom the risk of cancer is equivalent to an age-matched population, thereby justifying discontinuation of surveillance.
International multicenter study involving presumed BD-IPMN without worrisome features (WFs) or high-risk stigmata (HRS) at diagnosis who underwent surveillance. Clusters of individuals at risk for cancer development were defined according to cyst size and stability for at least 5 years, and age-matched controls were used for comparison using standardized incidence ratios (SIRs) for pancreatic cancer.
Of 3844 patients with presumed BD-IPMN, 775 (20.2%) developed WFs and 68 (1.8%) HRS after a median surveillance of 53 (interquartile range 53) months. Some 164 patients (4.3%) underwent surgery. Of the overall cohort, 1617 patients (42%) remained stable without developing WFs or HRS for at least 5 years. In patients 75 years or older, the SIR was 1.12 (95% CI, 0.23-3.39), and in patients 65 years or older with stable lesions smaller than 15 mm in diameter after 5 years, the SIR was 0.95 (95% CI, 0.11-3.42). The all-cause mortality for patients who did not develop WFs or HRS for at least 5 years was 4.9% (n = 79), and the disease-specific mortality was 0.3% (n = 5).
The risk of developing pancreatic malignancy in presumed BD-IPMN without WFs or HRS after 5 years of surveillance is comparable to that of the general population depending on cyst size and patient age. Surveillance discontinuation could be justified after 5 years of stability in patients older than 75 years with cysts <30 mm, and in patients 65 years or older who have cysts ≤15 mm.
目前，大多数分支胰管内乳头状黏液性肿瘤（BD-IPMN）患者接受无限期监测，导致医疗保健成本增加，但预防癌症的获益存在疑问。本研究旨在确定癌症风险等同于匹配年龄人群的患者，从而证明停止监测是合理的。
本国际多中心研究纳入了诊断时无担忧特征（WFs）或高危标志物（HRS）的疑似 BD-IPMN 患者，他们接受了监测。根据囊肿大小和至少 5 年的稳定性，定义了癌症发生风险较高的个体簇，并使用胰腺癌标准化发病率比（SIRs）比较了年龄匹配的对照组。
在 3844 例疑似 BD-IPMN 患者中，775 例（20.2%）在中位随访 53（四分位距 53）个月后出现了 WFs，68 例（1.8%）出现了 HRS。有 164 例（4.3%）患者接受了手术。在整个队列中，1617 例（42%）患者至少 5 年未出现 WFs 或 HRS，且病情稳定。在 75 岁或以上的患者中，SIR 为 1.12（95%CI，0.23-3.39），而在 65 岁或以上、直径小于 15mm 的稳定病变患者中，SIR 为 0.95（95%CI，0.11-3.42）。至少 5 年未出现 WFs 或 HRS 的患者的全因死亡率为 4.9%（n=79），疾病特异性死亡率为 0.3%（n=5）。
在经过 5 年的监测后，无 WFs 或 HRS 的疑似 BD-IPMN 患者发生胰腺恶性肿瘤的风险与一般人群相当，取决于囊肿大小和患者年龄。对于 75 岁以上、囊肿<30mm 的患者，以及 65 岁以上、囊肿≤15mm 的患者，如果在 5 年的稳定期后，可以考虑停止监测。
