de la Fuente Jaime, Lui Jacob, Lennon Ryan J, Chatterjee Arjun, Graham Rondell P, Zhang Lizhi, Kendrick Michael L, Truty Mark J, Cleary Sean P, Smoot Rory L, Nagorney David M, Gleeson Ferga C, Levy Michael J, Chandrasekhara Vinay, Pearson Randall K, Petersen Bret T, Vege Santhi S, Chari Suresh T, Majumder Shounak
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Department of Internal Medicine, Columbia University Irving Medical Center and the Vagelos College of Physicians and Surgeons, New York, New York.
Gastro Hep Adv. 2022 Jul 19;1(6):1099-1107. doi: 10.1016/j.gastha.2022.07.004. eCollection 2022.
Management of intraductal papillary mucinous neoplasms (IPMNs) relies on clinical and imaging features to select patients for either pancreatectomy or periodic image-based surveillance. We aimed to compare outcomes in patients with IPMNs who underwent surgery at diagnosis with those who underwent surgery after a period of surveillance and identify preoperative clinical and imaging features associated with advanced neoplasia.
Patients with surgically resected IPMN (n = 450) were divided into 2 groups: "immediate surgery": resection within 6 months of IPMN detection, and "surveillance surgery": resection after surveillance >6 months. Survival was analyzed with Kaplan-Meier estimates and Cox proportional hazard models.
Pancreatic cancers in the surveillance surgery group (n = 135) was more frequently stage I compared with the immediate surgery group (9/13, 69.2% vs 41/110, 37.3%; = .027). Among Fukuoka "worrisome features," only main pancreatic duct dilation 5-9 mm (odds ratio [OR] = 3.12, 95% confidence interval [CI]: 1.72-5.68; < .001) and serum CA 19-9≥ 35 U/mL (OR = 2.82, 95% CI: 1.31-6.06; = .008) were significantly associated with advanced neoplasia. In addition, smoking history was associated with increased risk of advanced neoplasia (OR = 2.05, 95% CI: 1.23-3.43). Occurrence of future cancer was 16-fold higher in IPMN with high-grade dysplasia when compared with low-grade dysplasia (hazard ratio: 16.5; 95% CI: 4.19-64.7).
Surveillance-detected pancreatic cancers in patients with IPMNs are more frequently stage I, and IPMN-HGD on surgical pathology is associated with significant risk of future pancreatic cancer. In addition to known "high-risk" features, main pancreatic duct dilation 5-9 mm, CA 19-9 elevation, and smoking history are significantly associated with advanced neoplasia.
导管内乳头状黏液性肿瘤（IPMN）的管理依赖于临床和影像学特征，以选择接受胰腺切除术或定期影像学监测的患者。我们旨在比较诊断时接受手术的IPMN患者与经过一段时间监测后接受手术的患者的预后，并确定与肿瘤进展相关的术前临床和影像学特征。
将接受手术切除的IPMN患者（n = 450）分为两组：“即刻手术”组，即IPMN检测后6个月内进行切除；“监测手术”组，即监测超过6个月后进行切除。采用Kaplan-Meier估计法和Cox比例风险模型分析生存率。
与即刻手术组相比，监测手术组（n = 135）的胰腺癌I期更为常见（9/13，69.2%对41/110，37.3%；P = 0.027）。在福冈“可疑特征”中，只有主胰管扩张5-9 mm（比值比[OR]=3.12，95%置信区间[CI]：1.72-5.68；P<0.001）和血清CA 19-9≥35 U/mL（OR = 2.82，95% CI：1.31-6.06；P = 0.008）与肿瘤进展显著相关。此外，吸烟史与肿瘤进展风险增加相关（OR = 2.05，95% CI：1.23-3.43）。与低级别异型增生相比，高级别异型增生的IPMN发生未来癌症的风险高16倍（风险比：16.5；95% CI：4.19-64.7）。
监测发现的IPMN患者的胰腺癌更常见为I期，手术病理显示的IPMN-HGD与未来胰腺癌的显著风险相关。除了已知的“高危”特征外，主胰管扩张5-9 mm、CA 19-9升高和吸烟史与肿瘤进展显著相关。
