Invasive and Noninvasive Progression After Resection of Noninvasive Intraductal Papillary Mucinous Neoplasms.
Invasive and Noninvasive Progression After Resection of Noninvasive Intraductal Papillary Mucinous Neoplasms.
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DOI：
10.1097/sla.0000000000004488
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发表时间：
2022-08-01
影响因子：
9
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确定切除的非侵袭性导管内乳头状黏液性肿瘤（IPMN）的发生频率、进展模式（侵袭性vs非侵袭性）和进展的风险因素。IPMN切除后，残余胰腺存在进展风险。从1995年到2018年，共有449名连续切除IPMN的患者被纳入研究。排除浸润性癌或随访< 6个月的患者。无创性进展定义为新的IPMN、主胰管尺寸增大和现有病变尺寸增大（与术前影像学检查相比> 5 mm）。侵袭性进展定义为残留胰腺中发生侵袭性癌症或转移性疾病。中位随访时间为48.9个月，124例患者（27.6%）发生进展; 108例（24.1%）为非侵入性进展，16例（3.6%）为侵入性进展。浸润性进展的中位进展随访时间较长（85.4 vs 55.9个月; P = 0.001）。5年和10年侵袭性进展的累积发生率估计值分别为6.4%和12.9%，而非侵袭性进展的累积发生率估计值分别为26.9%和41.5%。风险调整后，多灶性（HR 4.53，95% CI 1.34-15.26; P = 0.02）和原始切除术中的高度异型增生（HGD）（HR 3.60，95% CI 1.13-11.48; P = 0.03）与浸润性进展相关。非侵袭性IPMN手术切除后数年可进展为侵袭性癌。原始切除中的HGD是浸润性进展的风险因素，但一些低度异型增生病例也进展为癌症。具有HGD和多灶性囊肿等高危特征的患者应考虑进行更密集的监测，并代表未来试验的重要队列，如抗炎或预防性免疫治疗。
To define frequencies, pattern of progression (invasive vs noninvasive), and risk factors of progression of resected noninvasive intraductal papillary mucinous neoplasms (IPMNs). There is a risk of progression in the remnant pancreas after resection of IPMNs. Four hundred forty-nine consecutive patients with resected IPMNs from 1995 to 2018 were included to the study. Patients with invasive carcinoma or with follow-up < 6 months were excluded. Noninvasive progression was defined as a new IPMN, increased main pancreatic duct size, and increased size of an existing lesion (5 mm compared with preoperative imaging). Invasive progression was defined as development of invasive cancer in the remnant pancreas or metastatic disease. With a median follow-up of 48.9 months, progression was identified in 124 patients (27.6%); 108(24.1%) with noninvasive and 16 (3.6%) with invasive progression. Median progression follow-up was longer for invasive progression (85.4 vs 55.9 months; P = 0.001). Five-and 10-year estimates for a cumulative incidence of invasive progression were 6.4% and 12.9% versus 26.9% and 41.5% for noninvasive progression. After risk adjustment, multifocality (HR 4.53, 95% CI 1.34–15.26; P = 0.02) and high-grade dysplasia (HGD) in the original resection (HR 3.60, 95% CI 1.13–11.48; P = 0.03) were associated with invasive progression. Progression to invasive carcinoma can occur years after the surgical resection of a noninvasive IPMN. HGD in the original resection is a risk factor for invasive progression but some cases of low-grade dysplasia also progressed to cancer. Patients with high-risk features such as HGD and multifocal cysts should be considered for more intensive surveillance and represent an important cohort for future trials such as anti-inflammatory or prophylactic immunotherapy.