Progression Patterns in the Remnant Pancreas after Resection of Non-Invasive or Micro-Invasive Intraductal Papillary Mucinous Neoplasms (IPMN)

Efishat, Mohammad Al; Attiyeh, Marc A.; Eaton, Anne; Gönen, Mithat; Baştürk, Olca; Klimstra, David S.; D’Angelica, Michael I.; DeMatteo, Ronald P.; Kingham, T. Peter; Balachandran, Vinod P.; Jarnagin, William R.; Allen, Peter J.

doi:10.1245/s10434-018-6445-2

Cited by 33 publications

(30 citation statements)

References 23 publications

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“…38,39 Conversely, accumulating evidence suggests that patients with branch-duct IPMNs may remain at high risk of developing pancreatic carcinoma after 5-year surveillance. 9,[40][41][42] Few large studies have examined pancreatic carcinogenesis associated with branch-duct IPMNs specifically among patients with no considerable change during 5-year surveillance. In a study at a US referral center, high-grade dysplasia and invasive carcinoma were observed in 20 (5.5%) and 16 (4.4%) patients, respectively, of 363 patients included at the time of 5 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

et al. 2020

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“…In addition to intrapancreatic recurrence during follow-up, the possibility of extrapancreatic recurrence should also be considered. Extrapancreatic recurrence from non-invasive IPMN is thought to be rare [10,11,14,[19][20][21][22], although metastatic recurrence of invasive IPMN to extrapancreatic organs was reported at a high rate of 45-57% [20,23]. Thus, a protocol for long-term postoperative surveillance is required so as not to miss any recurrence after IPMN resection because the risk of intra-and extrapancreatic recurrence increases year by year.…”

Section: Discussionmentioning

confidence: 99%

Independent predictors of secondary invasive pancreatic remnant tumors after initial resection of an intraductal papillary mucinous neoplasm: a nationwide large-scale survey in Japan

2020

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Purpose There is no standardized surveillance protocol after intraductal papillary mucinous neoplasm (IPMN) resection. We report the findings of a large-scale survey in Japan, investigating the independent predictors of secondary invasive tumors by analyzing the epidemiology of secondary tumors of the remnant pancreas after initial IPMN resection. Methods An institutional questionnaire about the remnant pancreas after pancreas resection was distributed at the 41st Annual Meeting of the Japanese Society of Pancreatic Surgery in Tokyo. We retrospectively analyzed the patient data including pathological diagnosis, postoperative outcomes, and evaluation methods. Results Redo pancreatectomy was performed for secondary disease in 213 (1.4%) of a total 15,777 patients. Eighty-eight of these 213 patients had undergone initial resection of IPMN. The types of secondary tumors after IPMN resection significantly depended on those of the primary tumors. Through short-interval and long-term follow-up, most of the secondary tumors were detected within 1–4 years. Logistic regression analysis revealed that the initial pathological diagnosis of invasive IPMN was an independent predictor of secondary invasive tumors in the remnant pancreas. Conclusion Primary invasive IPMN proved to be a significant predictor of secondary invasive IPMN. Both short-interval and long-term follow-up may help to determine the prognosis of patients after IPMN resection.

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“…These results support the ndings of most previous studies on IPMN. [20][21][22] Kerlakian et al, demonstrated that jaundice was more often seen in patients with uncinate or head cysts (14.9% vs. 1.9%, p < 0.01) and that incidentally discovered or asymptomatic IPMN were more likely in patients with tumors located in the neck, body, or tail of the pancreas (53.3% vs. 31.0%, p < 0.01). 23 Furthermore, the median time from diagnosis to surgery was shorter.…”

Section: Discussionmentioning

confidence: 99%

A Novel Staging System and Clinical Predictive Nomogram for More Accurate Staging and Prognosis of Malignant Pancreatic Intraductal Papillary Mucinous Neoplasms: A Population-Based Study

Zhang¹,

Gao²,

Chen³

et al. 2020

Preprint

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Background: The current guidelines of the American Joint Committee on Cancer (AJCC) for the staging of exocrine pancreatic tumors seem inapplicable to malignant pancreatic intraductal papillary mucinous neoplasms (IPMN). Therefore, we aimed to improve the accuracy of clinical staging and prognosis for malignant IPMN.Methods: We extracted data of 2001 patients with malignant IPMN from the Surveillance, Epidemiology, and End Results database between 2000 and 2016. Of these, 1401 patients were assigned to the primary cohort and 600 patients to the validation cohort.Results: In Kaplan-Meier analysis of the primary cohort, the current AJCC guidelines were unable to distinguish between certain tumor substages (IA and IB in the 7th, IB and IIA in the 8th). The modified system we regrouped based on the median overall survival and hazard ratios was superior in tumor stage classifications. Age > 70 years, tumors located in the body or tail, high-grade differentiated tumors, surgery, chemotherapy, and TNM stage were identified as independent predictive factors of overall survival. Compared to that of TNM-based systems, the concordance index of the clinical predictive nomogram significantly improved (0.819; 95% confidence interval, 0.805–0.833), with excellent area under the receiver operating characteristic curves (1-, 3-, and 5-year: 0.881, 0.889, and 0.879, respectively). The calibration curves also showed good agreement between prediction and actual observation. In the analysis of treatment modalities, surgery resulted in better survival for all resectable IPMN. Chemotherapy is the treatment of choice for locally advanced or distant metastases patients.Conclusion: Our modified staging system improves the distinction of tumor stages. The nomogram was a more accurate and clinically reliable tool in prognosis prediction of patients with IPMN.

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Progression Patterns in the Remnant Pancreas after Resection of Non-Invasive or Micro-Invasive Intraductal Papillary Mucinous Neoplasms (IPMN)

Abstract: In this study, 22% of patients had disease progression following resection of noninvasive or microinvasive IPMN; 16% of these progressions represented invasive disease. These patients represent a high-risk group and should undergo long-term radiographic surveillance.

Cited by 33 publications

References 23 publications

Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

Independent predictors of secondary invasive pancreatic remnant tumors after initial resection of an intraductal papillary mucinous neoplasm: a nationwide large-scale survey in Japan

A Novel Staging System and Clinical Predictive Nomogram for More Accurate Staging and Prognosis of Malignant Pancreatic Intraductal Papillary Mucinous Neoplasms: A Population-Based Study

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