Pancreatic cystic lesions: descriptive epidemiology and natural history

描述（由申请人提供）：胰腺囊性病变：描述性流行病学和自然史。 胰腺囊肿的发病率稳步上升，这与广泛使用新的成像技术有关，主要是CT和MRI。偶然性胰腺囊肿的诊断范围从2.6%到20%，取决于成像方式和人群。目前的困境是，具有恶性潜力的囊肿占所有囊肿的约50%，并且作为浸润性癌症的5年生存率为d50%。然而，通常不清楚哪些囊肿会进展，部分原因是对这些病变的流行病学和自然史知之甚少。此外，无论恶性潜力如何，目前的指南建议根据囊肿大小，位置，症状和患者手术资格决定“观察和等待”或手术切除。癌症预防是手术的目标，但手术的显著发病率和 与手术切除相关的死亡率不容忽视。因此，继续研究，有助于更精细的子分类和诊断的囊肿是或将发展为癌症的需要，以防止不必要的手术，表征高风险人群，改善预后和增加知识的研究不足，这些病变的自然史。第二个好处是这项工作也有可能揭示胰腺发生。我们的目标是：1）确定1996年至2015年在UCSF接受腹部CT或MRI的40岁以上患者的囊肿病变发生率; 2）对于在UCSF随访的囊肿患者，从医学，病理学和实验室记录中提取前瞻性临床和结局数据，以确定与囊肿进展/恶性肿瘤相关的因素，并确定存档生物标本以供储存。将胰腺囊肿患者与SEER癌症登记数据联系起来，以确定癌症结局; 3）按5岁年龄组、性别、成像原因和成像方式将囊肿病例的频率匹配对照（无囊肿），以确定与胰腺囊肿风险相关的人口统计学和临床因素。我们预计将从约50，000项研究中确定约2，000例胰腺囊肿患者。将使用描述性统计量、校正的多变量考克斯回归（包括时间依赖性协变量）和非条件logistic回归分析来说明研究目的。实现我们的总体目标，开发一个丰富的注释数据库登记的腹部成像确定（偶然和非偶然）胰腺囊肿患者在加州大学旧金山分校，将使进一步研究未充分研究的因素与胰腺囊肿的风险和进展，并按类型。更重要的是，由于胰腺囊肿的公共登记不存在，我们的项目处于有利地位，可以建立基础设施和资源，以支持未来的前瞻性队列，以确定以下因素：1）了解有助于囊肿发展的生物学机制; 2）预测进展和恶性肿瘤; 3）更好地定义风险组，以进行更密切的监测或干预。全面了解胰腺囊肿流行病学和自然史对于为患者提供最佳护理选择至关重要，并有可能增加有关早期胰腺发生的新数据，以告知筛查和治疗目标。

DESCRIPTION (provided by applicant): Pancreatic cystic lesions: descriptive epidemiology and natural history. A steady increase in incidence of pancreatic cysts has been documented and is related to widespread use of new imaging technologies, mainly CT and MRI. Incidental pancreatic cyst diagnosis ranges from 2.6% to 20% depending on imaging modality and population. The dilemma is that cysts with malignant potential account for ~50% of all cysts and have a d50% 5-year survival as invasive cancers. Yet, it is often unclear which cysts will progress partly due to the poorly understood epidemiology and natural history of these lesions. Further, regardless of malignant potential, current guidelines recommend either "watch and wait" or surgical resection with decisions based on cyst size, location, symptoms and patient eligibility for surgery. Cancer prevention is the goal of surgery but the significant morbidity and mortality associated with surgical resection cannot be ignored. Thus, continued research that contributes to finer sub-classification and diagnosis of cysts that are or will progress to cancer s needed to prevent unnecessary surgery, characterize high risk populations, improve prognosis and increase knowledge of the understudied natural history of these lesions. A secondary benefit is the potential that this work also will shed light on pancreatogenesis. Our aims are to: 1) Determine cyst lesion incidence in patients e40 years old who received an abdominal CT or MRI at UCSF from 1996-2015; 2) For cyst patients followed at UCSF, abstract prospective clinical and outcome data from medical, pathology and laboratory records to determine factors related to cyst progression/ malignancy and identify archival biospecimens for banking. Link pancreatic cyst patients with SEER cancer registry data to determine cancer outcomes and; 3) Frequency- match controls (no cyst) to cyst cases by 5-year age group, sex, reason for imaging and imaging modality to determine demographic and clinical factors related to pancreatic cyst risk. We expect to identify about 2,000 incident pancreatic cyst patients from review of ~50,000 studies. Descriptive statistics, adjusted multivariable Cox regression including with time-dependent covariates, and unconditional logistic regression analyses will be used to address the study aims. Achievement of our overarching goal, to develop a richly annotated database registry of abdominal imaging-identified (incidental and non-incidental) pancreatic cyst patients at UCSF, will enable further research of understudied factors related to risk and progression of pancreatic cysts and by type. More importantly, as public registries of pancreatic cysts do not exist, our project is well-positioned to build the infrastructure and resources for support of futue prospective cohorts to identify factors to 1) understand biological mechanisms contributing to cyst development; 2) predict progression and malignancy and; 3) better define at-risk groups for closer monitoring or intervention. A comprehensive understanding of pancreatic cyst epidemiology and natural history is of utmost importance to provide the best options for patient care and has the potential to add new data about early pancreatogenesis to inform screening and therapeutic targets.