胰腺导管内乳头状黏液性肿瘤恶变预测因素的研究进展

Predictors of malignant intraductal papillary mucinous neoplasm of the pancreas

胰腺导管内乳头状黏液性肿瘤(IPMN)是发病率最高的胰腺囊性肿瘤,具有恶变倾向,而IPMN发生癌变后,患者的5年生存率不足40%。因此,早期识别恶变病例并手术切除可明显改善患者预后。各临床指南依据影像学特征、临床表现及血清肿瘤标志物等推荐了IPMN恶变的相关因素,其中主胰管扩张≥10 mm、存在实性成分或强化的壁结节及梗阻性黄疸等是公认的高危因素。然而,临床实践表明,现有指南推荐的危险因素对预测IPMN恶变的准确率并不高,主要问题在于指南推荐的危险因素特异度较低,使可随访观察的病例接受了非必要的手术切除。近年来,基因组学、影像组学及人工智能等新技术和新方法的发展极大推动了IPMN的研究进展。内镜超声下肿瘤囊液穿刺结合DNA、RNA等分子检测及影像组学结合机器学习建模等均在提高恶变IPMN的预测准确率方面展现了优越性,未来将成为辅助IPMN诊疗的重要工具。

Intraductal papillary mucinous neoplasm(IPMN)is the most common pancreatic cystic neoplasm with a tendency to malignancy,and the 5-year survival rate of patients with invasive IPMN is less than 40%.Therefore,early detection of malignant cases and surgical intervention will significantly improve patient outcomes.The clinical guidelines recommended risk factors for IPMN malignancy according to imaging characteristics,clinical manifestations and serum tumor markers,among which dilation of the main pancreatic duct≥10 mm,the presence of solid components or enhanced mural nodules,and obstructive jaundice were recognized as high-risk factors.However,clinical practice has shown that the risk factors recommended by the current guidelines are not highly accurate in predicting IPMN malignancy,and the main problem is that the guidelines are less specific and allow follow-up cases to undergo unnecessary surgical resection.In recent years,the development of new technologies and methods such as genomics,radiomics,and artificial intelligence has greatly promoted the research progress of IPMN.Endoscopic ultrasound-guided fine needle aspiration of cystic fluid combined with molecular detection such as DNA and RNA,as well as radiomics combined with machine learning modeling,have shown superiority in improving the prediction accuracy of malignant IPMN,and will become an important tool to assist the diagnosis and treatment of IPMN in the future.