Factors Associated With the Risk of Progression of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms

Abstract

IMPORTANCE Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common pancreatic preneoplastic lesions, but their surveillance is not personalized. OBJECTIVE To investigate patient-and cyst-related factors associated with progression into worrisome features (WFs) or high-risk stigmata (HRS) categories of BD-IPMNs. DESIGN, SETTING, AND PARTICIPANTS Cyst-and patient-related factors of consecutive BD-IPMNs without WFs or HRS in 540 patients diagnosed from 2009 to 2018 with at least 12 months' surveillance until February 28, 2020, were registered in a 2-center ambispective cohort study in Italy. In a subgroup, the ABO blood group was studied for the first time in this setting. EXPOSURE Cyst-related and patients-related factors and ABO blood group. MAIN OUTCOMES AND MEASURES The study outcome was the appearance of WFs or HRS according to the 2017 International Association of Pancreatology guidelines. Survival probability was calculated using Kaplan-Meier curve and risk factors identified by Cox proportional hazards regression. ABO blood group was inferred through genotypes with DNA extraction. RESULTS Of 540 patients with BD-IPMNs (median age, 66 years [interquartile range, 58.5-72.0 years]; 337 women [62.4%]) undergoing surveillance for a median of 51.5 months (interquartile range, 28-84 months) for 2758 person-years, 130 patients (24.1%) experienced progression. Probability of progression was 3.7% at 1 year, 23.4% at 5 years, and 43.3% at 10 years; 15 patients (2.8%) underwent surgery, 7 patients (1.3%) had malignant histologic findings, and 3 patients (0.56%) died of pancreatic-associated disease. Initial cyst size greater than 15 mm (hazard ratio [HR], 2.05; 95% CI, 1.44-2.91), body mass index greater than 26.4 (HR, 1.72; 95% CI, 1.19-2.50), and heavy smoking (HR, 1.81; 95% CI, 1.14-2.86) were significant independent factors associated with progression risk. The AA blood genotype was also associated with progression risk (HR, 3.49; 95% CI, 1.04-11.71) compared with the OO genotype in the investigated subgroup. CONCLUSIONS AND RELEVANCE This analysis of factors associated with progression of BD-IPMNs according to recent guidelines suggests that cyst size alone is not a reliable factor for estimation of progression risk; however, along with other readily available data, size is helpful for planning personalized surveillance of BD-IPMNs.

International external validation of a stratification tool to identify branch‐duct intraductal papillary mucinous neoplasms at lowest risk of progression

“…The cohorts from the two Italian centers have been described previously. 25 The cyst surveillance databases received…”

“…We combined prospectively maintained databases on pancreatic cyst surveillance from three university hospitals: the Yale New Haven Hospital (New Haven, USA), the San Raffaele Scientific Institute (Milan, Italy), and the San Andrea Hospital (Rome, Italy). The cohorts from the two Italian centers have been described previously 25 . The cyst surveillance databases received institutional review board approval in all centers (2000020031 Yale, 133/2016 San Raffaele, 251/2012 San Andrea).…”

“…The cohorts from the two Italian centers have been described previously. 25 The cyst surveillance databases received institutional review board approval in all centers (2000020031 Yale, 133/2016 San Raffaele, 251/2012 San Andrea). Written informed consent was obtained from all Italian participants prior to enrollment.…”

Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management

“…Capurso et al [ 46 ] investigated patient- and cyst-related factors associated with progression into WF or HRS categories of BD-IPMNs. This study included 540 patients diagnosed from 2009 to 2018 with at least 12 mo of surveillance until February 28, 2020.…”

“…The higher association of AA group compared to 00 group with progression was also associated. The authors concluded that IPMN diameter alone is not a sufficient for the assessment of progression risk; however, it is useful in correlation with correlated with other features in observation of BD-IPMN patients[ 46 ].…”