BACKGROUND & AIMS: Long-term outcomes of patients with branch-duct intraductal papillary mucinous neoplasms (IPMNs), particularly those after 5 years of surveillance, have not been fully evaluated in large studies. We analyzed incidences of IPMN-derived carcinoma and concomitant ductal adenocarcinoma (pancreatic ductal adenocarcinoma [PDAC]) over 20 years in a large population of patients. METHODS: We identified 1404 consecutive patients (52% women; mean age, 67.5 years) with a diagnosis of branch-duct IPMN, from 1994 through 2017, at the University of Tokyo in Japan. Using a competing risk analysis, we estimated cumulative incidence of pancreatic carcinoma, overall and by carcinoma type. We used competing risks proportional hazards models to estimate subdistribution hazard ratios (SHRs) for incidences of carcinomas. To differentiate IPMN-derived and concomitant carcinomas, we collected genomic DNA from available paired samples of IPMNs and carcinomas and detected mutations in GNAS and KRAS by polymerase chain reaction and pyrosequencing. RESULTS: During 9231 personyears of follow-up, we identified 68 patients with pancreatic carcinomas (38 patients with IPMN-derived carcinomas and 30 patients with concomitant PDACs); the overall incidence rates were 3.3%, 6.6%, and 15.0% at 5, 10, and 15 years, respectively. Among 804 patients followed more than 5 years, overall cumulative incidence rates of pancreatic carcinoma were 3.5% at 10 years and 12.0% at 15 years from the initial diagnosis. The size of the IPMN and the diameter of the main pancreatic duct associated with incidence of IPMNderived carcinoma (SHR 1.85; 95% confidence interval 1.38-2.48 for a 10-mm increase in the IPMN size and SHR 1.56; 95% confidence interval 1.33-1.83 for a 1-mm increase in the main pancreatic duct diameter) but not with incidence of concomitant PDAC. CONCLUSIONS: In a large long-term study of patients with branch-duct IPMNs, we found the 5year incidence rate of pancreatic malignancy to be 3.3%, reaching 15.0% at 15 years after IPMN diagnosis. We observed heterogeneous risk factor profiles between IPMNderived and concomitant carcinomas.

Objective It has been discussed whether IgG4-related disease (IgG4-RD), including autoimmune pancreatitis (AIP), is associated with malignancy; however, the issue has not been clarified. Methods We analyzed 113 patients with IgG4-RD in whom malignancy was not diagnosed at the time of IgG4-RD onset and the follow-up period was longer than six months. A total of 95 patients had AIP. The mean follow-up period was 73 months. The incidence of the observed malignancies was compared with the expected incidence in an age-and sex-matched general Japanese population based on the Vital Statistics of Japan. Results There were 15 malignancies (lung cancer in five patients, pancreatic cancer in two patients, gastric cancer in two patients, bile duct cancer in one patient, renal cancer in one patient, breast cancer in one patient, tongue cancer in one patient, malignant melanoma in one patient and acute myeloid leukemia in one patient) in 14 patients during the follow-up period. The calculated standardized incidence rate of the total malignancies was not significant, that is, 1.04 (95% CI 0.57-1.75). Conclusion The incidence of total malignancies in IgG4-RD patients is similar to that observed in the general population. At present, it is reasonable to conclude that IgG4-RD is not associated with an increased incidence of total malignancies.

Background:A nomogram is progressively being used as a useful predictive tool for cancer prognosis. A nomogram to predict survival in nonresectable pancreatic cancer treated with chemotherapy has not been reported.Methods:Using prospectively collected data on patients with nonresectable pancreatic cancer receiving gemcitabine-based chemotherapy at five Japanese hospitals, we derived a predictive nomogram and internally validated it using a concordance index and calibration plots.Results:In total, 531 patients were included between June 2001 and February 2013. The American Joint Committee on Cancer (AJCC) TNM stages were III and IV in 204 and 327 patients, respectively. The median survival time of the total cohort was 11.3 months. A nomogram was generated to predict survival probabilities at 6, 12, and 18 months and median survival time, based on the following six variables: age; sex; performance status; tumour size; regional lymph node metastasis; and distant metastasis. The concordance index of the present nomogram was higher than that of the AJCC TNM staging system at 12 months (0.686 vs 0.612). The calibration plots demonstrated good fitness of the nomogram for survival prediction.Conclusions:The present nomogram can provide valuable information for tailored decision-making early after the diagnosis of nonresectable pancreatic cancer.

Rescue EUS-BD was used in 3.1% among all ERCP. Given the comparable technical success and AE rates of both primary and rescue EUS-BD, primary EUS-BD without failed ERCP can be a treatment option if it provides advantages over ERCP.

Procalcitonin predicted severe acute cholangitis better than conventional biomarkers. Severe cases for which urgent biliary drainage is indicated might be identified on admission on the basis of the cutoff values for procalcitonin suggested in this study.

ST cessation resulted in a high rate of clinical relapses, even in patients with long-term maintenance therapy. Therefore, it appears desirable to continue steroid maintenance therapy for a period >3 years to prevent relapse.

The rate of exocrine pancreatic insufficiency in unresectable PC was high, and PERT can potentially improve the nutritional status during chemotherapy.

Summary:There is considerable interest in developing banks of frozen umbilical cord blood cells for transplants but it is uncertain how long frozen cells survive. Our objective was to determine the recovery of frozen umbilical cord blood cells. We quantitated recovery of hematopoietic progenitor cells (CFU-GM, BFU-E, and CFU-GEMM) from frozen umbilical cord blood cells stored for up to 12 years. Decay rates of CFU-GM, BFU-E and CFU-GEMM Umbilical cord blood cells are increasingly used for transplant, especially when no HLA-identical sibling donor is available. Consequently, there is growing interest in developing frozen HLA-typed cord blood banks.Umbilical cord blood cells in these banks may be stored for several years before use. However, there are few data on long-term survival of frozen cord blood cells; most reports focus on relatively short storage intervals. 1 We studied viability of hematopoietic progenitor cells in 12 umbilical cord blood samples frozen for up to 12 years. Materials and methodsBetween July 1985 and September 1985, cord blood samples were obtained from the placenta of 12 healthy volunteer mothers at delivery (38 to 41 weeks of gestation). Informed consent was obtained from all. Immediately after delivery of the baby, while the placenta was still in utero, the umbilical cord was double-clamped 6 to 8 cm from the baby and cord blood collected. Before collection, the venepuncture site was cleaned with alcohol and betadine. An 18 gauge needle was inserted into the umbilical vein and cord blood was aspirated into a 50 ml syringe containing 5 ml of ACD. The volume of cord blood collected ranged from 28 ml to 45 ml. The umbilical cord blood was processed using standard techniques. 2 Ficoll-Hypaque (Pharmacia, Uppsala, Sweden) gradient centrifugation was used to isolate the mononuclear cell fraction, which was resuspended at concentration of 2 ϫ 10 7 /ml. Mean (s.d.) mononuclear cell recovery was 48 Ϯ 11%. Umbilical cord blood mononuclear cells were cryopreserved using a programmable freezer (model 801 CryoMed, Mt Clemens, Ml, USA), using standard cryopreservation programs, in RPMI-1640 media, 10% DMSO and 20% fetal calf serum 3 and stored in the liquid phase of liquid nitrogen.Cells were thawed after 1 and 6 months and 1, 2 and 12 years and a small aliquot removed to assess viable cell recovery (trypan-blue exclusion test) and to assay hematopoietic progenitor cells (CFU-GM, BFU-E and CFU-GEMM) by standard techniques. 3 Recovery was calculated by comparing numbers of cells to 1 month values. StatisticsA linear model was applied to the logarithm of cell viability results. Logarithmic transformation was used to stabilize variance in observed recoveries. For a given progenitor cell assay, the model is:Log (viability) ϭ a ϩ b interval cryopreserved when the estimate of slope (b) ϭ 0, there is no trend for cell loss over time. Results were expressed as a decay factor (d) with 95% confidence intervals.Decay over time (k) was calculated as d k .