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

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Author information

Affiliations

  • 1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
      Authors
    • Oyama H 1
    • Tada M 1
    • Tateishi K 1
    • Hamada T 1
    • Nakai Y 1
    • Hakuta R 1
    • Ijichi H 1
    • Ishigaki K 1
    • Kanai S 1
    • Kogure H 1
    • Mizuno S 1
    • Saito K 1
    • Saito T 1
    • Sato T 1
    • Suzuki T 1
    • Takahara N 1
    • Koike K 1
    (17 authors)
  • 2. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan.
      Authors
    • Takagi K 2
    (1 author)
  • 3. Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
      Authors
    • Morishita Y 3
    • Tanaka M 3
    • Fukayama M 3
    (3 authors)
  • 4. Hepato-Pancreatico-Biliary Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
      Authors
    • Arita J 4
    • Hasegawa K 4
    (2 authors)

ORCIDs linked to this article

Gastroenterology, 29 Aug 2019, 158(1):226-237.e5
https://doi.org/10.1053/j.gastro.2019.08.032 PMID: 31473224 

A comment on this article appears in "Does Pancreatic Cyst Stability Justify Stopping Intraductal Papillary Mucinous Neoplasm Surveillance?" Gastroenterology. 2020 Jan;158(1):44-46.

Abstract 

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 person-years 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 IPMN-derived 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 5-year 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 IPMN-derived and concomitant carcinomas.

Full text links 

Read article at publisher's site: https://doi.org/10.1053/j.gastro.2019.08.032

Read article for free, from open access legal sources, via Unpaywall: http://www.gastrojournal.org/article/S0016508519412572/pdfUnpaywall

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Funding 

Funders who supported this work.

Akiko Kunita

    Atsushi Tanaka

      Department of Gastroenterology

        Department of Gastroenterology and Hepatology

          Department of Pathology

            Department of Radiology

              Department of Surgery

                Graduate School of Medicine

                  Hepato-Pancreatico-Biliary Surgery Division

                    Hiroyuki Isayama

                      Hokkaido University Hospital

                        Juntendo University

                          Kazumichi Kawakubo

                            Osamu Abe

                              Takeyuki Watadani

                                Teppei Morikawa

                                  The University of Tokyo

                                    Yoshikuni Kawaguchi