科学家或可鉴别出患高风险胰腺癌的病人

  当人们经过医学筛查发现机体胰腺发生病变，并且易于癌变后，他们非常惊恐，于是他们会主张进行高频率的CT筛查及活检测试来监控病变的进程，或者进行外科手术；然而医生并不知道这些异常病变是否具有潜在的危险，病人则会移去病变的胰腺组织来进行治疗，但通常这些病变组织并没有很么可担心的。
  近日，刊登在国际杂志Digestive and Liver Diseases上的一篇研究论文中，来自梅奥诊所的研究人员就鉴别出了哪些患者易于发生胰腺病变并且很有可能发展为胰腺癌。Michael B. Wallace教授指出，我们发现的可以增加胰腺癌风险的因子或许可帮助我们将高风险和低风险的个体进行区分，高风险的病人随后会进行高频率的扫描以及活检，亦或者是选择手术；而低风险的病人则不需要进行任何监督，其被关注的频率会较低一些。
  胰腺癌通常很难被早期诊断出来，大多数的病人都是在晚期才被诊断出来的，而且95%都是致死性的，因此研究者目前正在寻找方法来理解引发胰腺癌风险的因素；在研究中可以衍变成为癌性组织的病变组织通常被认为是胰腺导管内的乳头状黏液性肿瘤，其非常常见，大约10%至40%的个体都存在这种组织，而且很显然这些人中绝大多数并不会患胰腺癌。
  为了寻找方法来鉴别高风险的病人，研究者对胰腺发生病变的1126名患者进行了检测，在研究组中仅有84名个体患上了侵袭性的胰腺癌，而这些患者机体中拥有所有或部分使其患高风险胰腺癌的风险因子，包括吸烟史、肥胖、黄疸及脂肪泻；另外进行成像扫描发现的大尺寸的囊肿、总胰腺管的囊肿及囊肿壁根瘤的存在都是主要的风险因素；而腹痛也被认为是一种风险因子，而在研究中并未发现该风险因子。
  最后研究者Wallace表示，本文研究加强了当前治疗胰腺病变的指导准则，我们希望后期通过更多的研究，来确保这些携带有常见病变担心的患者并不会存在患胰腺癌的风险。（转化医学网360zhyx.com）
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转化医学网推荐的原文摘要：

Risk factors for malignant progression of intraductal papillary mucinous neoplasms
Digestive and Liver Diseases     doi:10.1016/j.dld.2015.03.007
Maria Moris, Massimo Raimondo, Timothy A. Woodward, Verna Skinner, Paolo G. Arcidiacono, Maria C. Petrone, Claudio De Angelis, Selene Manfrè, Pietro Fusaroli, Michael B. Wallace
Background
Intraductal papillary mucinous neoplasms of the pancreas are increasingly diagnosed. Due to their malignant potential, greater understanding of their nature is required.
Aims
Define risk factors for malignancy in intraductal papillary mucinous neoplasms.
Methods
An international, multicentre study was performed in Europe and the United States. Clinical databases were reviewed for patients with intraductal papillary mucinous neoplasms diagnosis.
Results
Of 1126 patients, 84 were diagnosed with invasive carcinoma/high-grade dysplasia and were compared to the rest of the cohort. Multivariate logistic analysis showed a statistically significant association between cancer/high-grade dysplasia and the variables smoking history (OR 1.9, 95% CI [1.1–3.1]), body mass index (OR 1.1, 95% CI [1–1.1]), symptoms (OR 3.4, 95% CI [1.9–6]), jaundice (OR 0.1, 95% CI [0–0.3]), and steatorrhea (OR 0.3, 95% CI [0.1–0.8]). Univariate analysis showed no association between malignancy and the cyst number/location (p?=?0.3 and p?=?0.5, respectively) although a strong association was shown for cyst size (p?
Conclusion
The presence of jaundice and steatorrhea, smoking, high body mass index, and imaging features such as cyst size, main duct involvement, and the presence and size of mural nodules are associated with high-grade neoplasia in intraductal papillary mucinous neoplasms.