Increased Prevalence of Precursor Lesions in Familial Pancreatic Cancer Patients.
Increased Prevalence of Precursor Lesions in Familial Pancreatic Cancer Patients.
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DOI：
10.1158/1078-0432.ccr-09-0004
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发表时间：
2009-12-15
期刊：
影响因子：
--
通讯作者：
Hruban RH
中科院分区：
文献类型：
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作者：
Shi C;Klein AP;Goggins M;Maitra A;Canto M;Ali S;Schulick R;Palmisano E;Hruban RH
将51例胰腺癌家族史患者切除的胰腺组织学结果与40例散发性胰腺癌患者切除的胰腺组织学结果进行比较。除了家族性胰腺癌，家族性组中没有一个患者有已知的遗传综合征。对前驱病变，包括胰腺上皮内瘤变（PanIN）、导管内乳头状粘液性肿瘤（IPMN）和初期IPMN进行定量。浸润性癌症采用既定的组织学标准进行分类。两组中识别的个体前驱病变在组织学上相似。前驱病变在家族性病例中比在散发病例中更常见。与散发病例相比，家族性病例中每平方厘米PanIN的相对发生率高出2.75倍（95%CI 2.05-3.70，根据年龄调整）。PanIN-3病变在家族性胰腺癌患者中比在散发性胰腺癌患者中更常见（相对比率4.20;经年龄校正的95%CI 2.22-7.93）。仅在家族性病例中观察到高级别的初期IPMN。51例家族性胰腺癌中的9例（18%）和40例散发性癌症中的4例（10%）与IPMN相关。在浸润性癌的类型中没有发现显著差异。非侵袭性前驱病变在具有强烈胰腺癌家族史的患者中比在具有散发性疾病的患者中更常见，并且前驱病变在具有强烈胰腺癌家族史的患者中级别更高。这些发现可以为设计胰腺肿瘤早期检测的筛查试验奠定基础。
Histologic findings in 51 pancreata resected from patients with a strong family history of pancreatic cancer were compared to the findings in 40 pancreata resected from patients with sporadic pancreatic cancer. None of the patients in the familial group had a known inherited syndrome, other than familial pancreatic cancer. Precursor lesions, including pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN) and incipient IPMN, were quantified. Invasive cancers were classified using established histologic criteria. The individual precursor lesions identified in both groups were histologically similar. Precursor lesions were more common in the familial cases than in the sporadic cases. The Relative Rate of PanINs per cm2 was 2.75 fold higher (95% CI 2.05-3.70, adjusted for age) in familial compared to sporadic cases. PanIN-3 lesions were more common in familial versus sporadic pancreatic cancer patients (Relative Rate 4.20; 95%CI 2.22-7.93 adjusted for age). High-grade incipient IPMNs were only observed in the familial cases. Nine (18%) of the 51 familial pancreatic cancers and 4 (10%) of the 40 sporadic cancers arose in association with an IPMN. No significant differences were found in the types of invasive cancers. Non-invasive precursor lesions are more common in patients with a strong family history of pancreatic cancer than in patients with sporadic disease, and precursor lesions are of a higher grade in patients with a strong family history of pancreatic cancer. These findings can form a basis for the design of screening tests for the early detection of pancreatic neoplasia.