ImportanceDespite the increasing prevalence of intraductal papillary mucinous neoplasm (IPMN), data on the growth and malignant conversion rates based on long-term surveillance cohorts are limited. Many international guidelines recommend surveillance for benign lesions, but the optimal interval and duration are unclear.ObjectiveTo determine the optimal surveillance protocol for IPMN and propose which patients may be exempted from surveillance.Design, Setting, and ParticipantsThis large-scale, international cohort study examined data of 3825 patients with IPMN treated at 5 tertiary pancreatic centers. Included were patients with branch duct (BD) IPMN who underwent surveillance or surgery between January 1, 1988, and December 31, 2020. After a thorough review, 3656 patients were included in the analytic sample. Changes in cyst size, worrisome features or high-risk stigmata, and malignant conversion rates were assessed. Patients who underwent surveillance over 5 years were compared to suggest discontinuation of surveillance protocol. Clinical data collection began in January 1, 2021, and the mean (SD) follow-up duration was 84 (47.7) months. The data analysis was performed from May 2, 2022, through September 14, 2022.ExposureThe patients with BD-IPMN were followed up based on International Association of Pancreatology guidelines. Patients with suspicious malignant neoplasms during surveillance underwent surgical resection.Main Outcome and MeasuresThe main outcome of this study was the optimal follow-up interval and duration of BD-IPMN surveillance. The association among cyst size, growth rate, and progression was examined using descriptive statistics.ResultsOf the 3656 patients with BD-IPMN in the analytic sample (1973 [54.0%] female; mean [SD] age, 63.7 [10.2] years), 172 (4.7%) were confirmed to have malignant lesions through surgery. Considering cyst growth, the time to develop worrisome features, and malignant conversion, a 1.5-, 1-, and 0.5-year surveillance interval could be optimal for cysts smaller than 20 mm, 20 to 30 mm, and 30 mm, respectively, after initial short-term (6-month) follow-up. Patients with cysts smaller than 20 mm, no worrisome features, and no growth during 5-year surveillance did not show malignant conversion after 5 years of follow-up and had time to progression of greater than 10 years.ConclusionsThese findings suggest that BD-IPMN surveillance may depend on the size of the cyst and morphologic changes at the initial 6-month follow-up. For patients with small cysts (ie, <20 mm) with no morphologic changes during the initial 5-year surveillance period, surveillance may be discontinued for those unfit for surgery or who have a limited life expectancy of 10 years or less.

中文翻译：

---

胰腺分支管内乳头状粘液性肿瘤的最佳监测间隔

重要性尽管导管内乳头状粘液性肿瘤（IPMN）的患病率不断增加，但基于长期监测队列的生长和恶变率数据仍然有限。许多国际指南建议对良性病变进行监测，但最佳间隔和持续时间尚不清楚。目的确定 IPMN 的最佳监测方案并提出哪些患者可以免于监测。设计、设置和参与者这项大规模的国际队列研究考察了5 个三级胰腺中心治疗的 3825 名 IPMN 患者的数据。其中包括 1988 年 1 月 1 日至 2020 年 12 月 31 日期间接受监测或手术的分支导管 (BD) IPMN 患者。经过彻底审查后，分析样本中纳入了 3656 名患者。评估了囊肿大小的变化、令人担忧的特征或高风险耻辱以及恶性转化率。对接受超过 5 年监测的患者进行比较，建议停止监测方案。临床数据收集于 2021 年 1 月 1 日开始，平均 (SD) 随访时间为 84 (47.7) 个月。数据分析的时间为2022年5月2日至2022年9月14日。暴露BD-IPMN患者根据国际胰腺学会指南进行随访。监测期间出现可疑恶性肿瘤的患者接受手术切除。主要结果和措施本研究的主要结果是BD-IPMN监测的最佳随访间隔和持续时间。使用描述性统计检查囊肿大小、生长速率和进展之间的关联。结果在分析样本中的 3656 名 BD-IPMN 患者中（1973 年 [54.0%] 女性；平均 [SD] 年龄，63.7 [10.2] 岁）， 172例（4.7%）通过手术确诊为恶性病变。考虑到囊肿生长、出现令人担忧的特征的时间和恶变，对于小于 20 毫米、20 至 30 毫米和 30 毫米的囊肿，最佳监测间隔分别为 1.5 年、1 年和 0.5 年。初步短期（6 个月）随访。囊肿小于 20 毫米、无令人担忧的特征且在 5 年监测期间无生长的患者在 5 年随访后未显示恶变，且进展时间超过 10 年。结论这些发现表明 BD-IPMN监测可能取决于囊肿的大小和最初 6 个月随访时的形态变化。对于小囊肿（即<20毫米）且在最初5年监测期间没有形态变化的患者，对于那些不适合手术或预期寿命有限为10年或更短的患者可以停止监测。