研究动态
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胰腺囊肿相关肿瘤、异形增生和导管腺癌的自然病程:微模拟模型的结果。

The natural disease course of pancreatic cyst associated neoplasia, dysplasia, and ductal adenocarcinoma; results of a microsimulation model.

发表日期:2023 Aug 24
作者: Brechtje D M Koopmann, Niels Dunnewind, Luuk A van Duuren, Iris Lansdorp-Vogelaar, Steffie K Naber, Djuna L Cahen, Marco J Bruno, Inge M C M de Kok,
来源: GASTROENTEROLOGY

摘要:

胰腺癌(PC)前体病变的进展估计很少。我们使用微模拟建模来了解PC及其前体病变的自然病程。这些信息对于探索PC筛查的有效性至关重要。我们开发了一个微模拟筛查分析(MISCAN)模型,该模型可以将胰内上皮肿瘤(PanIN)和囊肿从低级别(LGD)进化为高级别异型增生(HGD),最终进展为PC。该模型根据荷兰PC发病率数据和日本前体病变患病率数据(无PC尸检病例)进行了校准,并提供了PC进展的估计(前体病变起始、分期持续时间)。囊肿和PanIN的平均LGD状态持续时间为15.8年和17.1年。平均HGD状态持续时间为5.8年。对于进展到PC的病变,LGD病变的平均持续时间为4.8-4.9年,HGD病变的平均持续时间为4.0-4.1年。在13.7%的PC患者中,HGD状态持续时间少于一年。在存在任何囊肿的50岁个体中,未来20年内发展PC的概率估计为1.8%,而存在LGD粘液性囊肿的个体为6.1%。具有LGD PanIN的个体,这种20年PC风险估计为5.1%。在发展为PC之前,HGD病变的平均持续时间估计为4.0年。这意味着进行筛查的机会窗口存在,前提是有可靠的诊断测试的可用性。预测LGD囊肿进展为癌症的概率较低。版权所有 © 2023 AGA学会。由Elsevier Inc.出版。保留所有权利。
Estimates on the progression of precursor lesions to pancreatic cancer (PC) are scarce. We used microsimulation modelling to gain insight in the natural disease course of PC and its precursors. This information is pivotal to explore the efficacy of PC screening.We developed a Microsimulation Screening Analysis (MISCAN) model in which Pancreatic Intraepithelial Neoplasms (PanIN) and cysts can evolve from low (LGD) to high-grade dysplasia (HGD), to PC. The model was calibrated to Dutch PC incidence data and Japanese precursor prevalence data (autopsy cases without PC) and provides estimates of PC progression (precursor lesion onset, stage duration).The mean LGD state duration of cysts and PanIN is 15.8 and 17.1 years. The mean HGD state duration is 5.8 years. For lesions that progress to PC, the mean duration was 4.8-4.9 years for LGD lesions and 4.0-4.1 years for HGD lesions. In 13.7% of individuals who develop PC, the HGD state lasted shorter than a year. The probability that an individual at age 50 developed PC in the next 20 years was estimated to be 1.8% in the presence of any cyst and 6.1% in case of an LGD mucinous cyst. This 20 year PC risk was estimated to be 5.1% for individuals with an LGD PanIN.The mean duration of HGD lesions prior to development of PC was estimated to be 4.0 years. This implies a window of opportunity for screening, presuming the availability of a reliable diagnostic test. The probability that LGD cyst will progress to cancer was predicted to be low.Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.