Clinical Outcomes of Intraductal Papillary Mucinous Neoplasms With Dilatation of the Main Pancreatic Duct
Clinical Outcomes of Intraductal Papillary Mucinous Neoplasms With Dilatation of the Main Pancreatic Duct
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伴有主胰管扩张的导管内乳头状粘液性肿瘤的临床结果
DOI：
10.1016/j.cgh.2023.01.032
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发表时间：
2023
影响因子：
12.6
通讯作者：
Fujishiro Mitsuhiro
中科院分区：
文献类型：
--
作者：
Hamada Tsuyoshi;Oyama Hiroki;Nakai Yousuke;Tateishi Keisuke;Ushiku Tetsuo;Hasegawa Kiyoshi;Fujishiro Mitsuhiro
背景与目的主胰管扩张(MPD)已成为治疗导管内乳头状粘液性肿瘤(IPMN)的外科指征。方法在1994年至2021年确诊的3 610例胰腺囊肿患者中，我们确定了2 82 9例IPMN患者，其中包括2 82例MPD≥5 mm的患者，并对胰腺癌的短期(≤6个月)和长期风险进行了评估。结果在对282例MPD扩张症患者的近期预后分析中，72例(26%)患者通过手术或非手术探查确诊为胰腺癌。在对168例患者的长期随访中，我们记录了24例(14%)被诊断为胰腺癌的患者(18例为IPMN来源的癌，6例为伴发的导管腺癌)。MPD值为5~9.9 mm的患者2年和5年的胰腺癌累计诊断率分别为8.1%(95%可信区间，4.3%~13.5%)和10.0%(95%CI，5.5%~15.9%)，≥评分为10 mm的患者2、5年胰腺癌累计诊断发生率分别为16.0%(95%CI，3.6~36.5%)和33.3%(95%CI，10.3%~58.8%)。MPD5~9.9 mm组和≥10 mm组的多变量分布风险比分别为2.78(95%CI，1.5 7~4.90)和7.0 0(95%CI，2.5 8~19.0)。
Background & AimsDilatation of the main pancreatic duct (MPD) has been a surgical indication for intraductal papillary mucinous neoplasms (IPMNs). Few studies have investigated long-term outcomes of IPMNs with MPD dilatation.MethodsAmong 3610 patients diagnosed with pancreatic cysts between 1994 and 2021, we identified 2829 IPMN patients, including 282 patients with MPD ≥5 mm, and examined short-term (≤6 months) and long-term risks of pancreatic carcinoma. Utilizing competing risks proportional hazards models, we estimated subdistribution hazard ratios for incidence of pancreatic carcinoma with adjustment for potential confounders.ResultsIn analyses of short-term outcomes of the 282 patients with MPD dilatation, 72 (26%) patients were diagnosed with pancreatic carcinoma based on surgical or nonsurgical exploration. During long-term follow-up of 168 patients, we documented 24 (14%) patients diagnosed with pancreatic carcinoma (18 with IPMN-derived carcinoma and 6 with concomitant ductal adenocarcinoma). The patients with the MPD = 5-9.9 mm had cumulative incidence rates of pancreatic carcinoma diagnosis of 8.1% (95% confidence interval [CI], 4.3%–13.5%) and 10.0% (95% CI, 5.5%–15.9%) at 2 and 5 years, respectively; and the patients with the MPD ≥10 mm had the corresponding rates of 16.0% (95% CI, 3.6–36.5%) and 33.3% (95% CI, 10.3%–58.8%). The multivariable subdistribution hazard ratios were 2.78 (95% CI, 1.57–4.90) and 7.00 (95% CI, 2.58–19.0) for the MPD = 5-9.9 mm and ≥10 mm (vs <5 mm), respectively.ConclusionsIPMNs with MPD dilatation at baseline were associated with higher prevalence and incidence of pancreatic carcinoma compared with IPMNs with no MPD dilatation.