OBJECTIVE To describe the long-term natural history of branch duct intraductal papillary mucinous neoplasm (BD-IPMN). BACKGROUND The BD-IPMN is a known precursor of pancreatic cancer, yet its long-term natural history is largely unknown. METHODS We retrospectively reviewed patients with BD-IPMN who were followed at the Massachusetts General Hospital for at least 10 years without surgical intervention. Patient and cyst characteristics, development of worrisome features (WF), need for surgery, and malignancy were recorded. The risk of pancreatic cancer in this cohort was compared with the general population by determining the standardized incidence ratio. RESULTS Three hundred sixteen patients with BD-IPMN who were followed for at least 10 years without intervention were identified. The median age was 63 years, and the median follow-up was 13.5 years (range: 10-28.8 years). Median cyst size at diagnosis was 1.2 cm (IQR: 0.8-1.7), was 1.8 cm (IQR: 1.2-2.6) at 10 years, and increased to 2.0 cm (IQR: 1.3-3.0) by the end of surveillance. At the 10-year mark, 24% of patients had WF, and by the end of surveillance, an additional 20% had developed WF or high-risk stigmata. 8.2% of patients developed pancreatic malignancy (high-grade dysplasia or invasive cancer). The standardized incidence ratio for pancreatic cancer was 9.28 (95% CI: 5.82-14.06), with almost two-thirds of invasive cancers occurring within the pancreatic cyst. CONCLUSIONS After 10 years of surveillance for BD-IPMN without intervention, the disease continues to progress, and 1 of every 12 patients will develop malignancy. The risk of pancreatic cancer appears to be 9 times higher than in the comparable age-matched population.

中文翻译：

---

揭示分支导管内状粘液性肿瘤的长期自然史：超过 10 年。


目的 描述分支导管内状粘液性肿瘤 （BD-IPMN） 的长期自然病程。背景 BD-IPMN 是胰腺癌的已知前体，但其长期自然病程在很大程度上是未知的。方法 我们回顾性分析了在马萨诸塞州总医院随访至少 10 年且未手术干预的 BD-IPMN 患者。记录患者和囊肿特征、令人担忧的特征 （WF） 的发展、手术需求和恶性肿瘤。通过确定标准化发病率比，将该队列中胰腺癌的风险与一般人群进行比较。结果 确定了 316 例 BD-IPMN 患者，这些患者接受了至少 10 年的随访而没有干预。中位年龄为 63 岁，中位随访时间为 13.5 年 （范围： 10-28.8 岁）。诊断时中位囊肿大小为 1.2 cm （IQR： 0.8-1.7），10 年时为 1.8 cm （IQR： 1.2-2.6），监测结束时增加到 2.0 cm （IQR： 1.3-3.0）。在 10 年时，24% 的患者患有 WF，到监测结束时，另有 20% 的患者患上了 WF 或高危耻辱感。8.2% 的患者发展为胰腺恶性肿瘤 （高度异型增生或浸润性癌）。胰腺癌的标化发病率为 9.28 （95% CI： 5.82-14.06），近三分之二的浸润性癌发生在胰腺囊肿内。结论 BD-IPMN 监测 10 年无干预后，疾病继续进展，每 12 例患者中有 1 例会发展为恶性肿瘤。患胰腺癌的风险似乎比年龄匹配的可比人群高 9 倍。