在监测期间，小而稳定的胰腺囊肿预后良好：来自 PACYFIC 试验的结果。
Small and Stable Pancreatic Cysts Are Reassuring During Surveillance: Results From the PACYFIC Trial.
作者信息
Levink Iris J M, Sprij Marloes L J A, Koopmann Brechtje D M, Meziani Jihane, Jaarsma Sanne, van Riet Priscilla A, Overbeek Kasper A, Gorris Myrte, Voermans Rogier P, van Hooft Jeanin E, Casadei Riccardo, Di Marco Mariacristina, Wallace Michael B, Hoogenboom Sanne A, Azopardi Neville, Ahola Reea, Polkowski Marcin, Honkoop Pieter, Carrara Silvia, Schoon Erik J, Venneman Niels G, van der Waaij Laurens A, van Berkel Anne-Marie, Rossi Gemma, Bergmann Jilling F, Pando Elizabeth, Beyer Georg, Schwartz Matthijs P, van Vilsteren Frederike G I, Hoge Chantal, Smits Marianne E, Quispel Rutger, van Soest Ellert J, Vos Patrick M, Verdonk Robert C, Steinhauser Toon, Kouw Eva, Tan Adriaan C I T L, Czako Laszlo, Bruno Marco J, Cahen Djuna L
机构信息
Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
出版信息
United European Gastroenterol J. 2025 Jul;13(6):971-981. doi: 10.1002/ueg2.70043. Epub 2025 Jun 18.
BACKGROUND
Pancreatic cysts are increasingly discovered on imaging studies performed for unrelated conditions. Currently, surveillance of these lesions poses a substantial burden on patients, and health care recourses. We hypothesized that individuals with small and stable cysts have a diminutive risk of progressing to high-grade dysplasia (HGD) or pancreatic cancer (PC) that is similar to that in the general population.
METHODS
This nested PACYFIC-study is a collaboration among 44 centers in Europe and Northern-America, and investigates the risk of HGD and PC for different cyst sizes and growth rates in participants without baseline worrisome features (WF) or high-risk stigmata (HRS).
RESULTS
Of the 2369 PACYFIC participants, 975 met the inclusion criteria, with a mean age of 67 years (SD 13) and 65% being female. Of these, 438 individuals (45%) had a baseline small cyst size (< 15 mm), and 885 (91%) individuals had a slow growth rate (< 2.5 mm/year). During a median follow-up of 45 months (IQR 27), 20 individuals (2.1%) developed HGD, or PC. Individuals with small cysts had a 1.5-fold lower risk of developing WF or HRS (hazard ratio [HR] 0.7 [0.5-1.0], p = 0.03) than those with larger cysts but a similar risk of developing HGD or PC (p > 0.05). Slow growth was protective against the development of WF or HRS (HR 0.4 [0.2-0.6], p < 0.001) and HGD or PC (HR 0.04 [95% CI 0.02-0.12], p < 0.001). Individuals with small, stable sized cysts without baseline WF or HRS did not have a higher risk of HGD or PC than the general population (standardized incidence ratio [SIR] 1.13 [95% CI 0.01-6.30]).
CONCLUSION
Cyst size < 15 mm and growth rate < 2.5 mm/year appear to be "reassuring" features associated with a negligible risk of developing WF or HRS and HGD or PC. For cysts with these characteristics-and without baseline WF or HRS-less intensive surveillance (than currently recommended) or even cessation may be appropriate.
背景
在因无关病症进行的影像学检查中，胰腺囊肿越来越多地被发现。目前，对这些病变的监测给患者和医疗资源带来了沉重负担。我们推测，囊肿小且稳定的个体进展为高级别异型增生（HGD）或胰腺癌（PC）的风险极小，与普通人群相似。
方法
这项嵌套式PACIFIC研究是欧洲和北美的44个中心合作开展的，旨在调查在没有基线可疑特征（WF）或高危特征（HRS）的参与者中，不同囊肿大小和生长速度发生HGD和PC的风险。
结果
在2369名PACIFIC参与者中，975人符合纳入标准，平均年龄67岁（标准差13），65%为女性。其中，438人（45%）基线囊肿较小（<15mm），885人（91%）生长速度较慢（<2.5mm/年）。在中位随访45个月（四分位间距27）期间，20人（2.1%）发生了HGD或PC。囊肿较小的个体发生WF或HRS的风险比囊肿较大者低1.5倍（风险比[HR]0.7[0.5 - 1.0]，p = 0.03），但发生HGD或PC的风险相似（p>0.05）。生长缓慢可预防WF或HRS的发生（HR 0.4[0.2 - 0.6]，p<0.001）以及HGD或PC的发生（HR 0.04[95%CI 0.02 - 0.12]，p<0.001）。囊肿小且大小稳定、无基线WF或HRS的个体发生HGD或PC的风险并不高于普通人群（标准化发病比[SIR]1.13[95%CI 0.01 - 6.30]）。
结论
囊肿大小<15mm且生长速度<2.5mm/年似乎是“令人安心”的特征，与发生WF或HRS以及HGD或PC的风险可忽略不计相关。对于具有这些特征且无基线WF或HRS的囊肿，进行强度较低的监测（低于目前推荐的水平）甚至停止监测可能是合适的。
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