Multiinstitutional Validation Study of Cyst Fluid Protein Biomarkers in Patients With Cystic Lesions of the Pancreas.
Multiinstitutional Validation Study of Cyst Fluid Protein Biomarkers in Patients With Cystic Lesions of the Pancreas.
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DOI：
10.1097/sla.0000000000005314
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发表时间：
2022-08-01
影响因子：
9
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中科院分区：
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对因胰腺囊性病变接受内镜超声细针抽吸 (EUS-FNA) 治疗的病理未知患者的两种临床分子模型进行前瞻性评估。术前预测胰腺囊性肿瘤患者的组织学亚型（粘液性与非粘液性）和不典型增生的分级具有挑战性。我们小组之前发表了两张导管内乳头状粘液性肿瘤 (IPMN) 的临床分子列线图，其中结合了临床/放射学特征和囊液蛋白标记物（sFASL、CA72-4、MMP9、IL-4）。这项多机构研究纳入了因胰腺囊性病变而接受 EUS-FNA 的患者。有关切除的治疗建议基于标准临床、放射学和内窥镜特征。使用先前开发的临床分子列线图计算高风险 IPMN（高度不典型增生/浸润性癌症）的预测概率。囊液取自 100 名接受诊断性 EUS-FNA 的患者。该组中有 35 名患者接受了切除术，其中 65 名患者接受了放射学监测。在接受切除的组中，26 例患有低危 IPMN 或良性非 IPMN 病变，9 例患有高危 IPMN。在监测组中，中位随访 12 个月（范围：0.5-38）后，没有患者进展到切除或患上癌症。仅使用临床/放射线列线图，9 名高危 IPMN 患者中有 2 名的预测概率 >0.5。在临床分子模型中，模型 1 中的 9 名患者中有 6 名和模型 2 中的 9 名患者中有 6 名得分 >0.5。这项针对囊肿病理学未知的患者的前瞻性研究进一步证明了囊液蛋白分析在术前识别高危 IPMN 患者中的重要性。需要更长时间的随访来确定该模型是否适用于临床实践。本研究前瞻性评估了因胰腺囊性病变接受内镜超声细针抽吸 (EUS-FNA) 治疗的病理未知患者的两种临床分子模型（临床/放射学特征和囊液蛋白标记物）。结果表明，所有患有高危疾病的患者都属于前三分之一的患者，并且在两个模型中，9名患有高危病变的患者中有6人的预测概率大于0.5。这进一步验证了囊液生物标志物在识别高风险胰腺囊肿中的用途。
Prospective evaluation of two clinical-molecular models in patients with unknown pathology who underwent endoscopic ultrasound with fine-needle aspiration (EUS-FNA) for a cystic lesion of the pancreas. Preoperative prediction of histologic subtype (mucinous vs non-mucinous) and grade of dysplasia in patients with pancreatic cystic neoplasms is challenging. Our group has previously published two clinical-molecular nomograms for intraductal papillary mucinous neoplasms (IPMN) that incorporated both clinical/radiographic features and cyst fluid protein markers (sFASL, CA72-4, MMP9, IL-4). This multi-institutional study enrolled patients who underwent EUS-FNA for a cystic lesion of the pancreas. Treatment recommendations regarding resection were based on standard clinical, radiographic, and endoscopic features. Predicted probabilities of high-risk IPMN (high-grade dysplasia/invasive cancer) were calculated using the previously developed clinical-molecular nomograms. Cyst fluid was obtained from 100 patients who underwent diagnostic EUS-FNA. Within this group there were 35 patients who underwent resection, and 65 were monitored radiographically. Within the group that underwent resection, 26 had low-risk IPMN or benign non-IPMN lesions, and 9 had high-risk IPMN. Within the surveillance group, no patient progressed to resection or developed cancer after a median follow-up of 12 months (range: 0.5–38). Using the clinical/radiographic nomogram alone, 2 out of 9 patients with high-risk IPMN had a predicted probability >0.5. In the clinical-molecular models, 6 of 9 patients in model 1, and 6 of 9 in model 2, had scores >0.5. This prospective study of patients with unknown cyst pathology further demonstrates the importance of cyst fluid protein analysis in the preoperative identification of patients with high-risk IPMN. Longer follow-up is necessary to determine if this model will be useful in clinical practice. This study prospectively evaluates two clinical-molecular models (clinical/radiographic features and cyst fluid protein markers) in patients with unknown pathology who underwent endoscopic ultrasound with fine-needle aspiration (EUS-FNA) for a cystic lesion of the pancreas. Results demonstrated that all patients with high-risk disease fell in the top one third of patients, and in both models, 6 out of 9 patients with high-risk lesions had predicted probabilities greater than 0.5. This further validates the use of cyst fluid biomarkers in identification of high-risk pancreatic cysts.