Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
JAMA Netw Open. 2023 Oct 2;6(10):e2337799. doi: 10.1001/jamanetworkopen.2023.37799.
Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cysts that can give rise to pancreatic cancer (PC). Limited population data exist on their prevalence, natural history, or risk of malignant transformation (IPMN-PC).
To fill knowledge gaps in epidemiology of IPMNs and associated PC risk by estimating population prevalence of IPMNs, associated PC risk, and proportion of IPMN-PC.
DESIGN, SETTING, AND PARTICIPANTS: : This retrospective cohort study was conducted in Olmsted County, Minnesota. Using the Rochester Epidemiology Project (REP), patients aged 50 years and older with abdominal computed tomography (CT) scans between 2000 and 2015 were randomly selected (CT cohort). All patients from the REP with PC between 2000 and 2019 were also selected (PC cohort). Data were analyzed from November 2021 through August 2023.
CIs for PC incidence estimates were calculated using exact methods with the Poisson distribution. Cox models were used to estimate age, sex, and stage-adjusted hazard ratios for time-to-event end points.
The CT cohort included 2114 patients (1140 females [53.9%]; mean [SD] age, 68.6 [12.1] years). IPMNs were identified in 231 patients (10.9%; 95% CI, 9.7%-12.3%), most of which were branch duct (210 branch-duct [90.9%], 16 main-duct [6.9%], and 5 mixed [2.2%] IPMNs). There were 5 Fukuoka high-risk (F-HR) IPMNs (2.2%), 39 worrisome (F-W) IPMNs (16.9%), and 187 negative (F-N) IPMNs (81.0%). After a median (IQR) follow-up of 12.0 (8.1-15.3) years, 4 patients developed PC (2 patients in F-HR and 2 patients in F-N groups). The PC incidence rate per 100 person years for F-HR IPMNs was 34.06 incidents (95% CI, 4.12-123.02 incidents) and not significantly different for patients with F-N IPMNs compared with patients without IPMNs (0.16 patients; 95% CI, 0.02-0.57 patients vs 0.11 patients; 95% CI, 0.06-0.17 patients; P = .62). The PC cohort included 320 patients (155 females [48.4%]; mean [SD] age, 72.0 [12.3] years), and 9.8% (95% CI, 7.0%-13.7%) had IPMN-PC. Compared with 284 patients with non-IPMN PC, 31 patients with IPMN-PC were older (mean [SD] age, 76.9 [9.2] vs 71.3 [12.5] years; P = .02) and more likely to undergo surgical resection (14 patients [45.2%] vs 60 patients [21.1%]; P = .003) and more-frequently had nonmetastatic PC at diagnosis (20 patients [64.5%] vs 130 patients [46.8%]; P = .047). Patients with IPMN-PC had better survival (adjusted hazard ratio, 0.62; 95% CI, 0.40-0.94; P = .03) than patients with non-IPMN PC.
In this study, CTs identified IPMNs in approximately 10% of patients aged 50 years or older. PC risk in patients with F-N IPMNs was low and not different compared with patients without IPMNs; approximately 10% of patients with PC had IPMN-PC, and they had better survival compared with patients with non-IPMN PC.
导管内乳头状黏液性肿瘤（IPMNs）是可引发胰腺癌（PC）的胰腺囊肿。关于其流行率、自然史或恶性转化风险（IPMN-PC），目前仅有有限的人群数据。
通过估计 IPMNs 的人群流行率、相关 PC 风险和 IPMN-PC 的比例，填补 IPMNs 流行病学和相关 PC 风险方面的知识空白。
设计、地点和参与者：本回顾性队列研究在明尼苏达州奥姆斯特德县进行。使用罗切斯特流行病学项目（REP），对 2000 年至 2015 年间接受腹部计算机断层扫描（CT）的年龄在 50 岁及以上的患者进行随机选择（CT 队列）。还从 2000 年至 2019 年从 REP 中选择了所有患有 PC 的患者（PC 队列）。数据分析于 2021 年 11 月至 2023 年 8 月进行。
使用泊松分布的精确方法计算 PC 发病率估计的置信区间。Cox 模型用于估计年龄、性别和分期调整的时间到事件终点的风险比。
CT 队列包括 2114 名患者（1140 名女性[53.9%]；平均[标准差]年龄，68.6[12.1]岁）。在 231 名患者中发现了 IPMNs（10.9%；95%CI，9.7%-12.3%），其中大多数为分支胆管（210 个分支胆管[90.9%]、16 个主胆管[6.9%]和 5 个混合[2.2%] IPMNs）。有 5 个 Fukuoka 高危（F-HR）IPMNs（2.2%）、39 个令人担忧的（F-W）IPMNs（16.9%）和 187 个阴性（F-N）IPMNs（81.0%）。在中位数（IQR）随访 12.0（8.1-15.3）年后，4 名患者发生了 PC（2 名在 F-HR 组和 2 名在 F-N 组）。F-HR IPMNs 的 PC 发病率为每 100 人年 34.06 例（95%CI，4.12-123.02 例），与无 IPMNs 的患者相比，F-N IPMNs 患者的 PC 发病率无显著差异（0.16 例；95%CI，0.02-0.57 例与 0.11 例；95%CI，0.06-0.17 例；P = .62）。PC 队列包括 320 名患者（155 名女性[48.4%]；平均[标准差]年龄，72.0[12.3]岁），其中 9.8%（95%CI，7.0%-13.7%）患有 IPMN-PC。与 284 名非 IPMN PC 患者相比，31 名 IPMN-PC 患者年龄更大（平均[标准差]年龄，76.9[9.2] vs 71.3[12.5]岁；P = .02），更有可能接受手术切除（14 名患者[45.2%] vs 60 名患者[21.1%]；P = .003），更常为非转移性 PC 诊断（20 名患者[64.5%] vs 130 名患者[46.8%]；P = .047）。与非 IPMN-PC 患者相比，IPMN-PC 患者的生存情况更好（调整后的危险比，0.62；95%CI，0.40-0.94；P = .03）。
在这项研究中，CT 在 50 岁或以上的患者中发现了约 10%的 IPMNs。F-N IPMNs 患者的 PC 风险较低，与无 IPMNs 的患者无显著差异；约 10%的 PC 患者患有 IPMN-PC，与非 IPMN-PC 患者相比，他们的生存情况更好。
