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

Published on Nov 2, 2020
· DOI :10.1001/JAMANETWORKOPEN.2020.22933
Gabriele Capurso56
Estimated H-index: 56
,
Stefano Crippa60
Estimated H-index: 60
+ 10 AuthorsMaria Chiara Petrone19
Estimated H-index: 19
Sources
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.
References29
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#1Hiroki Oyama (UTokyo: University of Tokyo)H-Index: 4
#2Minoru Tada (UTokyo: University of Tokyo)H-Index: 60
Last. Kazuhiko Koike (UTokyo: University of Tokyo)H-Index: 91
view all 23 authors...
Abstract Background & Aims Long-term outcomes of patients with branch-duct intraductal papillary mucinous neoplasms (IPMNs), particularly those after 5 years if surveillance, have not been fully evaluated in large studies. We analyzed incidences of IPMN-derived carcinoma and concomitant ductal adenocarcinoma (PDAC) over 20 years in a large population of patients. Methods We identified 1404 consecutive patients (52% female; mean age, 67.5 years) with a diagnosis of branch-duct IPMN, from 1994 thr...
52 CitationsSource
1 CitationsSource
#1Giovanni Marchegiani (University of Verona)H-Index: 29
#2Stefano Andrianello (University of Verona)H-Index: 16
Last. Roberto Salvia (University of Verona)H-Index: 52
view all 10 authors...
OBJECTIVES:The management of small and incidental branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) still is of concern. The aim is assessing the safety of a surveillance protocol through the evaluation of their progression to malignancy.METHODS:All presumed BD-IPMNs observed from 2000
20 CitationsSource
#1Kasper A. Overbeek (Erasmus University Medical Center)H-Index: 3
#2Maaike Alblas (Erasmus University Medical Center)H-Index: 1
Last. Marco J. Bruno (Erasmus University Medical Center)H-Index: 23
view all 11 authors...
markdownabstractBackground: 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-branc...
8 CitationsSource
#1Nadine C.M. van Huijgevoort (UvA: University of Amsterdam)H-Index: 7
#2Marco Del Chiaro (Anschutz Medical Campus)H-Index: 31
Last. Marc G. Besselink (UvA: University of Amsterdam)H-Index: 84
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Pancreatic cystic neoplasms (PCN) are a heterogeneous group of pancreatic cysts that include intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystic neoplasms and other rare cystic lesions, all with different biological behaviours and variable risk of progression to malignancy. As more pancreatic cysts are incidentally discovered on routine cross-sectional imaging, optimal surveillance for patients with PCN is becoming an increasingly common clinical problem, highlight...
38 CitationsSource
#1Katherine E. Poruk (Johns Hopkins University)H-Index: 20
#2James D. Griffin (Johns Hopkins University)H-Index: 139
Last. Christopher L. Wolfgang (Johns Hopkins University)H-Index: 102
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Background Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions to the development of pancreatic adenocarcinoma. We determined if non-O blood groups are more common in patients with IPMN and if blood group is a risk factor for progression to invasive pancreatic cancer among patients with IPMN.
3 CitationsSource
#1Kazuhiro Kashiwagi (Keio: Keio University)H-Index: 11
#2Kazuhiro Minami (Keio: Keio University)H-Index: 5
Last. Takanori Kanai (Keio: Keio University)H-Index: 70
view all 8 authors...
OBJECTIVE: To identify risk factors of imaging progression (increase in cyst size or main pancreatic duct size, or a new mural nodule) in low-risk branch duct intraductal papillary mucinous neoplasm (BD-IPMN), including obesity-related factors such as pancreatic fat content. METHODS: Our hospital databases were searched for patients who had completed health checkup, including upper abdominal magnetic resonance imaging (MRI) over 48 months (August 2012 to July 2016). Individuals with BD-IPMN with...
1 CitationsSource
#1Jennifer M. Kolb (Mount Sinai Hospital)H-Index: 2
#1Jennifer M. Kolb (Mount Sinai Hospital)H-Index: 2
Last. Christopher J. DiMaio (Mount Sinai Hospital)H-Index: 19
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Background & Aims For patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs, cysts), it is a challenge to identify those at high risk for malignant lesions. We sought to identify factors associated with development of pancreatic cancer, focusing on neoplasm growth rate. Methods We performed a retrospective study of 189 patients with BD-IPMNs who underwent at least 2 contrast-enhanced cross-sectional imaging studies, 1 year or more apart, at a tertiary referral center from ...
12 CitationsSource
#1Maria Chiara Petrone (UniSR: Vita-Salute San Raffaele University)H-Index: 19
#2P. Magnoni (UniSR: Vita-Salute San Raffaele University)H-Index: 1
Last. Paolo Giorgio Arcidiacono (UniSR: Vita-Salute San Raffaele University)H-Index: 40
view all 9 authors...
The management of branch-duct IPMN remains controversial due to the relatively low rate of malignant degeneration and the uncertain predictive role of high-risk stigmata (HRS) and worrisome features (WFs) identified by the 2012 International Consensus Guidelines. Our aim was to evaluate the evolution of originally low-risk (Fukuoka-negative) BD-IPMNs during a long follow-up period in order to determine whether the appearance of any clinical or morphological variables may be independently associa...
13 CitationsSource
#1Marco Del ChiaroH-Index: 31
#2Marc G. Besselink (UniSR: Vita-Salute San Raffaele University)H-Index: 84
Last. L. WustenH-Index: 1
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Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts perf...
376 CitationsSource
Cited By2
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#1Tsuyoshi Hamada (UTokyo: University of Tokyo)H-Index: 38
#2Hiroki Oyama (UTokyo: University of Tokyo)H-Index: 4
Last. Kazuhiko Koike (UTokyo: University of Tokyo)H-Index: 91
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Background: ABO blood group has been associated with risks of various malignancies including pancreatic cancer. No study has evaluated the association of ABO blood group with incidence of pancreatic carcinogenesis during follow-up of patients with intraductal papillary mucinous neoplasms (IPMNs). Methods: Among 3,164 patients diagnosed with pancreatic cysts at the University of Tokyo from 1994 through 2019, we identified 1,815 IPMN patients with available data on ABO blood group. We studied the ...
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#1J.-Matthias Löhr (KI: Karolinska Institutet)H-Index: 19
#2Marco Del Chiaro (Anschutz Medical Campus)H-Index: 31
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