Smoking and IPMN malignant progression

Carr, Rosalie A.; Roch, Alexandra M.; Shaffer, K.; Aboudi, Saud; Schmidt, C. Max; DeWitt, John M.; Ceppa, Eugene P.; House, Michael G.; Zyromski, Nicholas J.; Nakeeb, Attila

doi:10.1016/j.amjsurg.2016.10.033

Cited by 17 publications

(13 citation statements)

References 8 publications

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“…A history of smoking and of acute pancreatitis are well‐established risk factors for pancreatic cancer, but not for the development of worrisome features in IPMN. Some studies suggest smoking accelerates progression of IPMN, and that it predicts invasive IPMN or concomitant pancreatic cancer in resected IPMN, but results are conflicting …”

Section: Discussionmentioning

confidence: 99%

Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Overbeek

Alblas

Gausman

et al. 2019

Aliment Pharmacol Ther

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Summary Background Because most pancreatic intraductal papillary mucinous neoplasms (IPMNs) will never become malignant, currently advocated long‐term surveillance is low‐yield for most individuals. Aim To develop a score chart identifying IPMNs at lowest risk of developing worrisome features or high‐risk stigmata. Methods We combined prospectively maintained pancreatic cyst surveillance databases of three academic institutions. Patients were included if they had a presumed side‐branch IPMN, without worrisome features or high‐risk stigmata at baseline (as defined by the 2012 international Fukuoka guidelines), and were followed ≥ 12 months. The endpoint was development of one or more worrisome features or high‐risk stigmata during follow‐up. We created a multivariable prediction model using Cox‐proportional logistic regression analysis and performed an internal‐external validation. Results 875 patients were included. After a mean follow‐up of 50 months (range 12‐157), 116 (13%) patients developed worrisome features or high‐risk stigmata. The final model included cyst size (HR 1.12, 95% CI 1.09‐1.15), cyst multifocality (HR 1.49, 95% CI 1.01‐2.18), ever having smoked (HR 1.40, 95% CI 0.95‐2.04), history of acute pancreatitis (HR 2.07, 95% CI 1.21‐3.55), and history of extrapancreatic malignancy (HR 1.34, 95% CI 0.91‐1.97). After validation, the model had good discriminative ability (C‐statistic 0.72 in the Mayo cohort, 0.71 in the Columbia cohort, 0.64 in the Erasmus cohort). Conclusion In presumed side branch IPMNs without worrisome features or high‐risk stigmata at baseline, the Dutch‐American Risk stratification Tool (DART‐1) successfully identifies pancreatic lesions at low risk of developing worrisome features or high‐risk stigmata.

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Section: Discussionmentioning

confidence: 99%

Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Overbeek

Alblas

Gausman

et al. 2019

Aliment Pharmacol Ther

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“…A pooled estimation only showed weak effect of secondhand tobacco smoke exposure on AIS/MIA incidence [13], and another study also observe no correlation between smoking history and invasive carcinoma [14]. However, it was also reported that tobacco exposure may accelerate malignant progression [15], and smoking is not a major cause of AIS but play a role in the progression from AIS to the invasive adenocarcinoma still with AIS features [16].…”

Section: Discussionmentioning

confidence: 99%

Features Based on Thin-section Computed Tomography Identify the Type of lung Adenocarcinoma

Li¹,

Zheng²,

Liu³

et al. 2020

Preprint

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Background: To investigate whether thin-section computed tomography (TSCT) features may efficiently guide the invasiveness basedclassification of lung adenocarcinoma. Methods: Totally, 316 lung adenocarcinoma patients (from 2011-2015) were divided into three groups: 56 adenocarcinoma in situ (AIS), 98 minimally invasive adenocarcinoma (MIA), and 162 invasive adenocarcinoma (IAC) according their pathological results. Their TSCT features, including nodule pattern, shape, pleural invasion, solid proportion, border, margin, vascular convergence, air bronchograms, vacuole sign, pleural indentation, diameter, solid diameter, and CT values of ground-glass nodules (GGN) were analyzed. Pearson’s chi-square test, Fisher’s exact test and One-way ANOVA were adopted tocomparebetweengroups. Receiver operating characteristic (ROC) analysis wereperformedto assess its value for prediction and diagnosis. Results: Patients with IAC were significantly elder than those in AIS or MIA group,and more MIA patients had a smoking history than AIS and IAC. No recurrence happened in the AIS and MIA groups, while 4.3% recurrences were confirmed in the IAC group. As for TSCT variables, we found AIS group showed dominantly higher 91.07%PGGN pattern and 87.50% round/oval nodules than that in MIA and IAC group. In contrast, MIA group showed more cases with undefined border and vascular convergence than AIS and IAC group. Importantly, IAC group uniquely showed higher frequency of pleural invasion compared with MIA and AIS group. The majority of patients (82.1%) in IAC group showed ≥ 50% solid proportion. We found diameter and solid diameter of the lesions were notably larger in the IAC group compared with AIS and MIA groupin quantitative aspect. In addition, for MGGNs, the CT values of ground-glass opacity (GGO) and ground-glass opacity solid portion (GGO-solid) were both higher in the IAC group than AIS and MIA. Finally, we also observed that smooth margin took a dominant proportion in the AIS group while most cases in the IAC group had a lobulate margin. Patients in MIA and IAC group shared higher level of air bronchograms and vacuole signs than AIS group. Conclusions: The unique features in different groups identified by TSCT had diagnosis value for lung adenocarcinoma.

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“…Capurso et al [10] compared 390 patients with IPMN with 390 matched controls and found that a history of DM, CP, and a family history of pancreatic cancer were all independent risk factors for IPMN. Carr et al [11] examined the association between IPMN malignant progression and smoking in 324 resected IPMNs and found no significant difference in the percentage of invasive IPMNs between smokers and nonsmokers (22 vs. 18%, p = 0.5). However, among patients with invasive IPMN, smokers were younger than nonsmokers at the time of diagnosis (65 vs. 72 years, p = 0.01).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies investigated the association of environmental, personal, and hereditary risk factors with the occurrence or degree of IPMN [10][11][12][13][14] . Capurso et al [10] compared 390 patients with IPMN with 390 matched controls and found that a history of DM, CP, and a family history of pancreatic cancer were all independent risk factors for IPMN.…”

Section: Discussionmentioning

confidence: 99%

Association between the Risk Factors for Pancreatic Ductal Adenocarcinoma and Those for Malignant Intraductal Papillary Mucinous Neoplasm

Kamata¹,

Takenaka²,

Nakai³

et al. 2017

Oncology

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Background and Aims: Risk factors for pancreatic ductal adenocarcinoma (PDAC) include diabetes mellitus, chronic pancreatitis, obesity, a family history of pancreatic cancer, and a history of smoking or alcohol consumption. The aim of this study was to evaluate the association between risk factors for PDAC and malignant intraductal papillary mucinous neoplasm (IPMN). Methods: The study included 134 consecutive patients with IPMN who underwent surgical resection at Kindai University Hospital between April 2009 and March 2015. Data on the presence or absence of mural nodules (MNs) and risk factors for PDAC were evaluated. Multivariable logistic regression analysis was performed with malignant IPMN as the outcome variable and MNs and risk factors for PDAC as explanatory variables. Results: The odds ratio of malignant IPMN to MNs was 3.88 (95% confidence interval [CI] 1.53-9.84; p = 0.004), whereas that of malignant IPMN to smoking history was 1.66 (95% CI 0.74-3.71; p = 0.22). When the presence of MNs was considered as a predictive factor for malignancy, the sensitivity and specificity were 88.5 and 32.1%, respectively, whereas when the presence of both smoking history and MNs was considered, the specificity improved to 73.2%, with a decrease in sensitivity to 42.3%. Conclusions: The presence of both a smoking history and MNs was a valuable predictive factor for malignant IPMN with high specificity. A smoking history should be considered before surgical resection in addition to the presence of MNs.

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Smoking and IPMN malignant progression

Cited by 17 publications

References 8 publications

Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Features Based on Thin-section Computed Tomography Identify the Type of lung Adenocarcinoma

Association between the Risk Factors for Pancreatic Ductal Adenocarcinoma and Those for Malignant Intraductal Papillary Mucinous Neoplasm

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