Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
J Gastroenterol. 2023 Oct;58(10):1068-1080. doi: 10.1007/s00535-023-02028-0. Epub 2023 Jul 29.
Trajectories of serological and morphological signatures have not been documented in pancreatic carcinogenesis related to intraductal papillary mucinous neoplasms (IPMNs).
Using a prospective cohort of 3437 IPMN patients, we identified 100 IPMN patients who developed pancreatic carcinomas during long-term surveillance. We examined serial changes of blood markers (carbohydrate antigen 19-9 [CA19-9], hemoglobin A1c [HbA1c], and pancreatic enzymes) and morphological features (worrisome features and high-risk stigmata) during the prediagnostic period of pancreatic carcinomas, overall and by carcinoma types (IPMN-derived vs. concomitant pancreatic carcinomas).
CA19-9 elevation was observed in 39 patients and was associated with a metastatic stage. Compared to IPMN-derived carcinomas, concomitant carcinomas were more likely to represent CA19-9 elevation (60% vs. 30%, respectively; P = 0.005). HbA1c levels elevated only in 3 patients. Pancreatic enzyme elevation was observed in 18 patients with no differences in frequencies between the carcinoma types. All patients with elevated levels of blood markers had positive findings on cross-sectional imaging. High-risk stigmata or worrisome features were observed in all patients but one with concomitant carcinoma. The most common types of worrisome features were the main pancreatic duct dilatation and CA19-9 elevation in IPMN-derived and concomitant carcinomas, respectively. Compared to IPMN-derived carcinomas, concomitant carcinomas were less likely to harbor high-risk stigmata (16% vs. 86%, respectively; P < 0.001).
The usefulness of currently available blood biomarkers was limited in early detection of pancreatic carcinomas related to IPMNs. Morphological alterations were well correlated with long-term risk of IPMN-derived carcinomas, but not with that of concomitant carcinomas.
在与导管内乳头状黏液性肿瘤（IPMN）相关的胰腺癌发生过程中，尚未记录血清学和形态学特征的轨迹。
我们使用 3437 例 IPMN 患者的前瞻性队列，确定了 100 例在长期监测期间发生胰腺癌的 IPMN 患者。我们检查了胰腺癌发生前的预诊断期内血液标志物（糖类抗原 19-9 [CA19-9]、糖化血红蛋白 [HbA1c] 和胰腺酶）和形态特征（令人担忧的特征和高危标志）的变化，包括总体情况和按癌类型（IPMN 衍生型与同时发生的胰腺癌）进行的分析。
39 例患者出现 CA19-9 升高，且与转移阶段相关。与 IPMN 衍生型癌相比，同时发生的癌更可能表现为 CA19-9 升高（分别为 60%和 30%；P=0.005）。仅 3 例患者的 HbA1c 水平升高。18 例患者出现胰腺酶升高，但两种癌类型之间的频率无差异。所有血液标志物水平升高的患者均在横断面成像上有阳性发现。所有患者均存在高危标志或令人担忧的特征，但同时发生的癌患者除外。最常见的令人担忧的特征类型分别为主胰管扩张和 IPMN 衍生型和同时发生的癌中的 CA19-9 升高。与 IPMN 衍生型癌相比，同时发生的癌更不可能存在高危标志（分别为 16%和 86%；P<0.001）。
目前可用的血液生物标志物在检测与 IPMN 相关的胰腺癌方面的作用有限。形态学改变与 IPMN 衍生型癌的长期风险密切相关，但与同时发生的癌的风险无关。
