Background and Aims: A higher incidence of extra-pancreatic malignancies (EPMs) in patients with pancreatic intraductal papillary mucinous neoplasm (IPMN) than in the general population has been shown in several studies. We suppose that EPMs also occur after IPMN has been diagnosed, but few reports have discussed the risk factors that have been identified, except for old age, which was only noted in one study. Our study aims to recognize the distribution of EPMs in Taiwanese patients with a longer duration of follow-up and investigate the risk factors to predict EPMs in IPMN patients. Methods: We retrospectively analyzed 114 patients with pancreatic IPMN from 1 January 2010 to 31 December 2014 in Chang Gung Memorial Hospital. The characteristics of the patients were all recorded. Different EPMs are demonstrated as occurring before, concurrently with, or after IPMN diagnosis. The risk factors were compared between patients with or without an EPM. Results: After an average follow-up duration of 10.45 years, 47 EPMs occurred in 42 patients (36.8%), and over half were found after IPMN was diagnosed (55.3%). The most common EPMs were colon cancer and lung cancer (21.3%). Moreover, cyst size progression was highly associated with EPM occurrence (p= 0.004) and predictive of EPM occurrence after IPMN (p= 0.002), with a cut-off value of 1 cm (accuracy: 79%; sensitivity: 88%; specificity: 58%). Conclusions: Colon cancer and lung cancer account for the majority EPMs in Taiwan. EPMs were also frequently found after IPMN diagnosis when the follow-up duration was prolonged up to 10.45 years. Cyst size progression is a risk factor of EPM after IPMN diagnosis and we suggest a cut-off value of 1 cm for clinical utility.
背景与目的：多项研究表明，胰腺导管内乳头状黏液性肿瘤（IPMN）患者发生胰腺外恶性肿瘤（EPMs）的几率高于普通人群。我们推测EPMs也可能在IPMN确诊后发生，但除一项研究仅提及高龄因素外，目前鲜有报告系统探讨已明确的风险因素。本研究旨在通过延长随访时间，明确台湾地区IPMN患者中EPMs的分布特征，并探究预测IPMN患者发生EPMs的风险因素。方法：我们回顾性分析了长庚纪念医院2010年1月1日至2014年12月31日期间收治的114例胰腺IPMN患者。详细记录所有患者的临床特征，并根据EPMs与IPMN诊断的时间关系（诊断前、同时或诊断后）进行分类统计。比较伴或不伴EPMs患者间的风险因素差异。结果：在平均10.45年的随访期内，42例患者（36.8%）共发生47例EPMs，其中超过半数（55.3%）在IPMN确诊后发现。最常见的EPMs为结肠癌与肺癌（21.3%）。进一步分析显示，囊肿大小进展与EPMs发生显著相关（p=0.004），且对IPMN确诊后发生的EPMs具有预测价值（p=0.002），其最佳截断值为1厘米（准确率：79%；敏感性：88%；特异性：58%）。结论：在台湾地区，结肠癌与肺癌构成IPMN患者EPMs的主要类型。当随访时间延长至10.45年时，IPMN确诊后发现的EPMs亦较为常见。囊肿大小进展是IPMN诊断后发生EPMs的风险因素，建议临床采用1厘米作为截断参考值。
肿瘤(癌症)患者之家