- 作者：Juntaro Matsuzaki? ; Hidekazu Suzuki? ; hsuzuki@a6.keio.jp ; Shigeo Okuda&Dagger ; ; Akihiro Tanimoto&Dagger ; ; Keiko Asakura§ ; ; Seiichiro Fukuhara? ; Sawako Okada? ; Kenro Hirata? ; Hideki Mori? ; Tatsuhiro Masaoka? ; Hajime Higuchi? ; Shigenari Hozawa? ; Sachio Kuribayashi&Dagger ; ; Toru Takebayashi§ ; ; Toshifumi Hibi?
- 关键词：Prognostic Factors ; Tumor Development ; Imaging Results ; Progression
- 刊名：Clinical Gastroenterology and Hepatology
- 出版年：2013
- 出版时间：May, 2013
- 年：2013
- 卷：11
- 期：5
- 页码：548-554
- 全文大小：1038 K
Background & Aims
There is controversy over the optimal management strategy for patients with branch-duct type intraductal papillary mucinous neoplasms of the pancreas (BD-IPMNs), precursors to pancreatic cancer. We aimed to identify factors associated with the presence of BD-IPMNs and changes in their diameter.Methods
Two separate analyses were conducted in a cohort of patients who underwent magnetic resonance cholangiopancreatography (MRCP) in a single year (2006). MRCP findings and clinical outcomes of these patients were followed for a maximum of 6 years. We evaluated initial MRCP findings and demographics associated with the presence of BD-IPMNs at baseline and increase in BD-IPMN diameter over time.
Results
During the follow-up period, 154 patients developed BD-IPMN and 322 patients did not. Older age, diabetes mellitus, gallbladder adenomyomatosis, and absence of gallstones were associated with the presence of BD-IPMNs at baseline. Increases in diameter of BD-IPMNs were associated with 3 baseline factors: BD-IPMN diameter greater than 17 mm, gallbladder adenomyomatosis, and a common bile duct diameter less than 5.5 mm. Patients with BD-IPMNs could be stratified into 4 groups with varying risk for the enlargement of BD-IPMNs over time: those with 3 risk factors (hazard ratio [HR], 11.4; 95 % confidence interval [CI], 3.4-37.8), 2 risk factors (HR, 4.7; 95 % CI, 1.7-12.8), or 1 risk factor (HR, 3.1; 95 % CI, 1.2-8.2) compared with those without risk factors.
Conclusions
For patients with BD-IPMNs, careful follow-up evaluation is particularly important for those with BD-IPMN >17 mm in size, common bile duct diameter <5.5 mm, or gallbladder adenomyomatosis.