Tange Shuichi, Oyama Hiroki, Kawaguchi Yoshikuni, Hakuta Ryunosuke, Hamada Tsuyoshi, Ishigaki Kazunaga, Kanai Sachiko, Noguchi Kensaku, Saito Tomotaka, Sato Tatsuya, Suzuki Tatsunori, Tanaka Mariko, Takahara Naminatsu, Ushiku Tetsuo, Hasegawa Kiyoshi, Nakai Yousuke, Fujishiro Mitsuhiro
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Am J Gastroenterol. 2025 Feb 1;120(2):449-458. doi: 10.14309/ajg.0000000000002966. Epub 2024 Jul 16.
Aging has been implicated in the development of various cancer types. No study has specifically investigated age at intraductal papillary mucinous neoplasm (IPMN) diagnosis in relation to the long-term risk of pancreatic carcinogenesis.
Within a prospective cohort of 4,104 patients diagnosed with pancreatic cysts, we identified 3,142 patients with IPMNs and examined an association of age at IPMN diagnosis with the incidence of pancreatic carcinoma. Using the multivariable competing-risks proportional hazards regression model, we estimated subdistribution hazard ratios (SHRs) and 95% confidence intervals (CIs) for pancreatic carcinoma incidence according to age at IPMN diagnosis.
During 22,187 person-years of follow-up, we documented 130 patients diagnosed with pancreatic carcinoma (64 with IPMN-derived carcinoma and 66 with concomitant ductal adenocarcinoma). Older age at IPMN diagnosis was associated with a higher risk of pancreatic cancer incidence ( Ptrend = 0.002). Compared with patients younger than 55 years, patients aged 55-64, 65-74, and ≥ 75 years had adjusted SHRs of 1.80 (95% CI, 0.75-4.32), 2.56 (95% CI, 1.10-5.98), and 3.31 (95% CI, 1.40-7.83), respectively. Patients aged 70 years and older had a numerically similar adjusted SHR compared with patients younger than 70 years with worrisome features defined by the international consensus guidelines (1.73 [95% CI, 1.01-2.97] and 1.66 [95% CI, 0.89-3.10], respectively).
Older patients with IPMNs were at a higher risk of developing pancreatic carcinoma during surveillance. Surgically fit elderly patients may be good candidates for periodic surveillance aimed at a reduction of pancreatic cancer-related deaths.
衰老与多种癌症类型的发生有关。尚无研究专门调查导管内乳头状黏液性肿瘤（IPMN）诊断时的年龄与胰腺癌发生的长期风险之间的关系。
在一个对4104例诊断为胰腺囊肿的患者进行的前瞻性队列研究中，我们确定了3142例IPMN患者，并研究了IPMN诊断时的年龄与胰腺癌发病率之间的关联。使用多变量竞争风险比例风险回归模型，我们根据IPMN诊断时的年龄估计了胰腺癌发病率的亚分布风险比（SHR）和95%置信区间（CI）。
在22187人年的随访期间，我们记录了130例诊断为胰腺癌的患者（64例为IPMN来源的癌，66例为同时发生的导管腺癌）。IPMN诊断时年龄较大与胰腺癌发病风险较高相关（Ptrend = 0.002）。与55岁以下的患者相比，55 - 64岁、65 - 74岁和≥75岁的患者调整后的SHR分别为1.80（95% CI，0.75 - 4.32）、2.56（95% CI，1.10 - 5.98）和3.31（95% CI，1.40 - 7.83）。根据国际共识指南定义的具有令人担忧特征的患者中，70岁及以上的患者与70岁以下的患者相比，调整后的SHR在数值上相似（分别为1.73 [95% CI，1.01 - 2.97]和1.66 [95% CI，0.89 - 3,10]）。
IPMN老年患者在监测期间发生胰腺癌的风险较高。身体状况适合手术的老年患者可能是旨在减少胰腺癌相关死亡的定期监测的良好候选者。
