Oyama Hiroki, Hamada Tsuyoshi, Nakai Yousuke, Tanaka Mariko, Takagi Kaoru, Fukuda Rintaro, Hakuta Ryunosuke, Ishigaki Kazunaga, Kanai Sachiko, Kawaguchi Yoshikuni, Kurihara Kohei, Nishio Hiroto, Noguchi Kensaku, Saito Tomotaka, Sato Tatsuya, Suzuki Tatsunori, Suzuki Yukari, Takaoka Shinya, Tange Shuichi, Takahara Naminatsu, Hasegawa Kiyoshi, Ushiku Tetsuo, Fujishiro Mitsuhiro
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Ann Surg. 2024 Mar 20. doi: 10.1097/SLA.0000000000006268.
To examine whether long-term surveillance of intraductal papillary mucinous neoplasms (IPMNs) leads to early diagnosis and better clinical outcomes of pancreatic ductal adenocarcinomas (PDACs) developing concomitantly with IPMNs.
Long-term image-based surveillance is recommended for patients with low-risk IPMNs. However, it is unknown whether the surveillance can improve surgical and survival outcomes of patients with concomitant PDACs.
Using a prospective single-institutional cohort of 4,620 patients with pancreatic cysts including 3,638 IPMN patients, we identified 63 patients who developed concomitant PDAC during long-term surveillance. We compared overall survival (OS) of 46 cases with concomitant PDAC to that of 460 matched cases diagnosed with non-IPMN-associated PDAC at the same institution. Multivariable hazard ratios and 95% confidence intervals (CIs) for overall mortality were computed using the Cox regression model with adjustment for potential confounders.
Concomitant PDACs were identified at an earlier cancer stage compared to non-IPMN-associated PDACs with 67% and 38% cases identified at stage 2 or earlier, respectively (P<0.001) and 57% and 21% cases with R0 resection, respectively (P<0.001). Compared to non-IPMN-associated PDACs, concomitant PDACs were associated with longer OS (P=0.034) with a multivariable hazard ratio of 0.61 (95% CI, 0.39-0.96). The 5-year survival rate of patients with concomitant PDAC was higher compared to patients with non-IPMN-associated PDAC (34% vs. 18%, respectively; P=0.018).
The surveillance for patients with IPMNs was associated with early identification of concomitant PDACs and longer survival of patients diagnosed with this malignancy.
探讨对导管内乳头状黏液性肿瘤（IPMN）进行长期监测是否能实现对与IPMN同时发生的胰腺导管腺癌（PDAC）的早期诊断并带来更好的临床结局。
对于低风险IPMN患者，建议进行基于图像的长期监测。然而，尚不清楚这种监测能否改善同时患有PDAC患者的手术和生存结局。
我们对一个包含4620例胰腺囊肿患者（其中3638例为IPMN患者）的前瞻性单机构队列进行研究，确定了63例在长期监测期间发生同时性PDAC的患者。我们将46例同时性PDAC患者的总生存期（OS）与在同一机构诊断为非IPMN相关PDAC的460例匹配病例的总生存期进行了比较。使用Cox回归模型计算总死亡率的多变量风险比和95%置信区间（CI），并对潜在混杂因素进行了校正。
与非IPMN相关的PDAC相比，同时性PDAC在更早的癌症阶段被发现，分别有67%和38%的病例在2期或更早阶段被发现（P<0.001），R0切除率分别为57%和21%（P<0.001）。与非IPMN相关的PDAC相比，同时性PDAC与更长的OS相关（P=0.034），多变量风险比为0.61（95%CI，0.39-0.96）。同时性PDAC患者的5年生存率高于非IPMN相关PDAC患者（分别为34%和18%；P=0.018）。
对IPMN患者的监测与同时性PDAC的早期识别以及被诊断为此种恶性肿瘤患者的更长生存期相关。
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