Survival Analysis and Risk for Progression of Intraductal Papillary Mucinous Neoplasia of the Pancreas (IPMN) Under Surveillance: A Single-Institution Experience

Chiaro, Marco Del; Ateeb, Zeeshan; Reuterwall-Hansson, Marcus; Rangelova, Elena; Segersvärd, Ralf; Kartalis, Nikolaos; Ansorge, Christoph; Löhr, Matthias; Arnelo, Urban; Verbeke, Caroline

doi:10.1245/s10434-016-5661-x

Cited by 93 publications

(79 citation statements)

References 24 publications

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“…Patients with high‐risk stigmata also had decreased DSS, whereas worrisome features and the diagnosis of IPMN without risk factors were not associated with mortality independent of the degree of dysplasia, unless invasive IPMN occurred. This supports previous reports of the low risk of progression of IPMN with worrisome features, but higher mortality, in patients with high‐risk stigmata under surveillance.…”

Section: Discussionsupporting

confidence: 91%

Management and outcomes of intraductal papillary mucinous neoplasms

et al. 2019

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Background This study evaluated the outcome and survival of patients with radiologically suspected intraductal papillary mucinous neoplasms (IPMNs). Methods IPMN management was reviewed according to Fukuoka risk factors and IPMN localization, differentiating main‐duct (MD), mixed‐type (MT) and branch‐duct (BD) IPMNs. Perioperative results were compared with those of patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) over the same interval (2010–2014). Overall (OS) and disease‐specific (DSS) survival rates were calculated and subgroups compared. Results Of 142 patients with IPMNs, 26 had MD‐IPMN, eight had MT‐IPMN and 108 had BD‐IPMN. Some 74 per cent of patients with MD‐ and MT‐IPMN were managed by primary resection, whereas this was used in only 27·8 per cent of those with BD‐IPMN. The risk of secondary resection and malignant transformation for BD‐IPMNs smaller than 20 mm was 8 and 2 per cent respectively during follow‐up. Pancreatic head resection of IPMNs was associated with an increased risk of postoperative pancreatic fistula grade B/C compared with resection of PDAC (12 of 33 (36 per cent) versus 41 of 221 (18·6 per cent) respectively; P = 0·010), and greater morbidity and mortality (Clavien–Dindo grade III: 15 of 33 (45 per cent) versus 56 of 221 (25·3 per cent) respectively; grade IV: 1 (3 per cent) versus 7 (3·2 per cent); grade V: 2 (6 per cent) versus 2 (0·9 per cent); P = 0·008). Five‐year OS and DSS rates in patients with MD‐IPMN were worse than those for MT‐ and BD‐IPMN (OS: 44, 86 and 97·4 per cent respectively, P < 0·001; DSS: 60, 100 and 98·6 per cent; P < 0·001). Patients with invasive IPMN had worse OS and DSS rates than those with non‐invasive dysplasia (OS: IPMN‐carcinoma (10 patients) 33 per cent, high‐grade dysplasia 100 per cent, intermediate‐grade dysplasia 63 per cent, low grade‐dysplasia 100 per cent, P < 0·001; DSS: IPMN‐carcinoma 43 per cent, all grades of dysplasia 100 per cent, P < 0·001). Patients with high‐risk stigmata had poorer survival than those without risk factors (OS: high‐risk stigmata (35 patients) 55 per cent, worrisome features (31) 95 per cent, no risk factors (76) 100 per cent, P < 0·001; DSS: 71, 100 and 100 per cent respectively, P < 0·001). Conclusion The risk of malignant transformation was very low for BD‐IPMNs, but the development of high‐risk stigmata was associated with disease‐specific mortality. Patients with IPMN had greater morbidity after resection than those having resection of PDAC.

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Section: Discussionsupporting

confidence: 91%

Management and outcomes of intraductal papillary mucinous neoplasms

et al. 2019

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“…In 2015, a meta‐analysis was published including 2177 patients under surveillance for SB‐IPMN, of which only 82 (3.7%) developed a pancreatic malignancy . Since then, several additional studies, each including at least 300 patients with at least 5 years of follow‐up, reported a pancreatic cancer risk of only 0%‐1.6% for small asymptomatic cysts . However, all these studies were retrospective and the actual, long‐term risk is yet to be determined by large and prospective studies.…”

Section: Introductionmentioning

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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“…In BD IPMNs, imaging surveillance is reasonable in asymptomatic patients (without obstructive jaundice, diabetes or acute pancreatitis) with lesions smaller than 4 cm, and without high risk stigmata (mural nodules, more than 6 mm dilatation of the MD or cytological atypia). Additionally, elevated serum carbohydrate antigen (CA) 19.9 levels or a growth rate of more than 2mm/year, are relative risk factors that should be considered in the evaluation of these patients (4,7,10). Applying the European guidelines to our patients, the 7 patients with adenocarcinoma would have undergone surgical resection, but 1 of the 4 tumors with highgrade dysplasia would not be resected (table 3).…”

Section: Discussion Discussionmentioning

confidence: 99%

Predictors of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms and Applicability of Current Guidelines

Devezas¹,

Queiros²,

Teixeira³

et al. 2018

SGO

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Introduction: Pancreatic intraductal papillary mucinous neoplasms (IPMN) are recognized as pre-malignant lesions, corresponding to less than 3% of all pancreatic exocrine neoplasms. The study objectives were: to evaluate the surgical results of our institution, to identify factors predicting malignancy in IPMN and to assess the validity of recently introduced IPMN guidelines in our population. Methods: A single center, retrospective study in patients submitted to surgical resection for IPMN was conducted, between 1/2008-6/2016, to identify predictive factors for malignancy, and to evaluate the surgical results. Results: Thirty-nine patients were submitted to a surgical resection. The median age was 68 years (61.5% females). Adenocarcinoma and high-grade dysplasia were present, in 7 and 4 patients, respectively. A significant association was identified with the phenotype and the degree of atypia (p = 0.001), and duct origin and degree of atypia (p = 0.026). Malignant transformation was associated with intestinal or pancreatic-biliary subtypes. Discussion and Conclusions: Applying the European guidelines, all adenocarcinoma would have undergone surgical resection, but 1 with high-grade dysplasia would not be resected. If we applied the American guidelines, 1 patient with adenocarcinoma and 3 with high-grade dysplasia wouldn´t be submitted to resection. The decision in patients with these lesions requires multidisciplinary teams and a tailored based approach.

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Survival Analysis and Risk for Progression of Intraductal Papillary Mucinous Neoplasia of the Pancreas (IPMN) Under Surveillance: A Single-Institution Experience

Cited by 93 publications

References 24 publications

Management and outcomes of intraductal papillary mucinous neoplasms

Management and outcomes of intraductal papillary mucinous neoplasms

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

Predictors of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms and Applicability of Current Guidelines

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