| セッション情報 | The 4th International ForumShort Oral Presentations（Pancreaticobiliary disorders 1） |
|---|---|
| タイトル | IF-SOP-10：Challenge to early detection of pancreatic ductal adenocarcinoma focused on surveillance of Intraductal Papillary Mucinous Neoplasm（IPMN）of the Pancreas |
| 演者 | Tamura Koji（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan） |
| 共同演者 | Ohtsuka T.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan）, Ideno N.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan）, Matsunaga T.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan）, Kimura H.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan）, Watanabe Y.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan）, Aso T.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan）, Ohuchida K.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan）, Takahata S.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan）, Oda Y.（Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Japan）, Mizumoto K.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan）, Tanaka M.（Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan） |
| 抄録 | IPMN has been recognized as a potential clue to early detection of pancreatic cancer. However, there have been few studies regarding the surveillance period/interval of resected or observed IPMNs. We previously demonstrated that deterioration of diabetes mellitus and abnormal serum CA 19-9 levels are independent factors predicting the presence of concomitant cancer in patients with IPMNs（Ann Surg 2010）. Therefore, we have been checking all the patients with IPMN who undergo resection or are surveyed without resection by assessing serum HbA1c/CA19-9 levels as well as alternate CT and MRCP using a 6-month protocol（Am J Surg 2012）. Despite such a strict protocol, some patients are diagnosed with unresectable distinct cancer. Therefore, factors to discriminate high risk patients who may develop concomitant cancer should be determined and such high risk patients should be surveyed by more sensitive diagnostic modalities such as ERCP or EUS for early detection of distinct cancer. In our recent study assessing 110 patients who underwent resection of IPMNs, IPMN with distinct cancer was found to be frequently of GNAS wild type（p＜0.001, OR=9.5）. According to GNAS status analysis of preoperative duodenal fluid（DF）samples in 23 of 110 patients, the accuracy of DF DNA testing to predict the GNAS status of matched tissue samples of resected IPMN was 91%（21/23）. GNAS status of DF would be useful to determine possibly high risk patients. In terms of early detection of distinct cancer, intense surveillance using additional EUS or ERCP for such high risk patients would be required. |
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