Pancreatic Ductal Adenocarcinomas in Long-Term Follow-Up Patients With Branch Duct Intraductal Papillary Mucinous Neoplasms
Pancreatic Ductal Adenocarcinomas in Long-Term Follow-Up Patients With Branch Duct Intraductal Papillary Mucinous Neoplasms
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DOI：
10.1097/mpa.0b013e3181b91cd0
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发表时间：
2010-01-01
期刊：
影响因子：
2.9
通讯作者：
Kohgo, Yutaka
中科院分区：
文献类型：
--
作者：
Tanno, Satoshi;Nakano, Yasuhiro;Kohgo, Yutaka
目的：分支导管内乳头状黏液性肿瘤(BD-IPMN)是一种生长缓慢且预后良好的肿瘤，但已有报道在BD-IPMNS患者中同时发生胰腺导管腺癌(PDA)。方法：对89例无附壁结节的BD-IPMN患者进行保守至少2年的随访期(中位随访期个月，范围25~158月)。所有受试者都接受了包括内窥镜逆行胰腺造影术在内的影像检查。根据日本厚生劳动省编制的生命统计数据计算标准化发病率(SIR)。结果：89例患者中，在552患者年(7.2/1000患者年)中观察到4例远离BD-IPMN的PDA。PDA的SIR为15.8(95%可信区间为4.3~40.4；P=0.00014)。亚组分析显示70岁及以上患者的PDA发生率显著增加(SIR16.7；95%CI，3.4~48.7；P=0.0008)和女性患者(SIR 22.5；95%CI，2.7~81.1；P=0.0037)。在随访期间，需要仔细检查BD-IPMNS患者的PDA的发展情况。
Objective: Although branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) are slow-growing tumors with a favorable prognosis, the synchronous occurrence of pancreatic ductal adenocarcinomas (PDAs) in patients with BD-IPMNs has been reported. This study was aimed to elucidate the development of PDAs in long-term follow-up patients with BD-IPMNs.Methods: We investigated 89 BD-IPMN patients who had no mural nodules and followed them up conservatively at least 2 years (median follow-up, 64 months; range, 25-158 months). All subjects underwent examinations by imaging modalities including endoscopic retrograde pancreatography. We calculated the standardized incidence ratio (SIR) from the vital statistics compiled by the Ministry of Health, Labor, and Welfare of Japan.Results: Among the 89 patients, 4 cases of PDAs distant from BD-IPMN were observed in 552 patient-years of follow-up (7.2 per 1000 patient-years). The expected number was 0.25, and the SIR of PDAs was 15.8 (95% confidence interval [CI], 4.3-40.4; P = 0.00014). Subgroup analyses showed that the incidence of PDAs was significantly increased in patients 70 years or older (SIR 16.7; 95% CI, 3.4-48.7; P = 0.0008) and in women (SIR 22.5; 95% CI, 2.7-81.1; P = 0.0037).Conclusions: Patients with BD-IPMNs are at a high risk for PDAs. During the follow-up, careful examination is required to detect the development of PDAs in patients with BD-IPMNs.