Risk Factors for Development of High-Risk Stigmata in Branch-Duct Intraductal Papillary Mucinous Neoplasms

Abstract Background: Strict follow-up is recommended for branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) to avoid missing the development of high-risk stigmata (HRS) at a premalignant stage. This study aimed to identify the risk factors associated with the development of HRS during follow-up.Methods: We performed a retrospective analysis of 283 patients with BD-IPMN, treated at the Okayama University Hospital in Japan between January 2009 and December 2016. Only patients with imaging studies indicative of classical features of BD-IPMN without HRS and followed for >1 year were included in the study. We performed radiological follow-up every 6 months and collected patients’ demographic data, cyst characteristics, and clinical outcomes. Cyst size was recorded at the initial and final imaging studies and growth rate was calculated. The primary outcome was to evaluate the risk factors for development of HRS in patients with BD-IPMN without HRS at the initial diagnosis.Results: Patients with BD-IPMN had a median follow-up of 53.3 months. Based on image analyses, a mean cysts size were initially 18.0 mm and their final size was 20.4 mm, and the mean annual cyst growth was 0.57 mm. Among them, 10 patients (3.5%) developed HRS after a median surveillance period of 55.8 months. Main pancreatic duct (MPD) size (5-9 mm) and cyst growth rate (>2.5 mm/year) were, both, independent risk factors for the development of HRS (odds ratio, 14.2; 95% CI, 3.1-65.2, P = .0006, and odds ratio, 6.1; 95% CI 1.5-25.5, P = .014). Considering the number of worrisome features (WFs), the rate of HRS development was not a WF: 2.0% (4/199), a single WF: 1.6% (1/62), multiple WFs: 22.7% (5/22), and significantly higher in multiple WFs (95% CI: 4.0–57.1; p=.0003).Conclusions: MPD dilation, rapid cyst growth, and multiple WFs were significant risk factors for the development of HRS. In the presence of such features, it is necessary to closely follow the development of HRS and avoid missing the best opportunity for surgical intervention.

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Mo1196 Risk Factors for the Development of Pancreatic Ductal Adenocarcinoma During the Follow-up of Branch Duct-Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

Gastroenterology ◽

10.1016/s0016-5085(12)62376-2 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-619

Author(s):

Koichiro Mandai ◽

Azumi Suzuki ◽

Soichiro Morikawa ◽

Takuji Kawamura ◽

Kenjiro Yasuda

Keyword(s):

Risk Factors ◽

Pancreatic Ductal Adenocarcinoma ◽

Ductal Adenocarcinoma ◽

Intraductal Papillary Mucinous Neoplasms ◽

Branch Duct ◽

Mucinous Neoplasms ◽

Branch Duct Type

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Cyst Growth Rate Predicts Malignancy in Patients With Branch Duct Intraductal Papillary Mucinous Neoplasms

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2010.09.008 ◽

2011 ◽

Vol 9 (1) ◽

pp. 87-93 ◽

Cited By ~ 135

Author(s):

Mee Joo Kang ◽

Jin–Young Jang ◽

Soo Jin Kim ◽

Kyoung Bun Lee ◽

Ji Kon Ryu ◽

...

Keyword(s):

Growth Rate ◽

Intraductal Papillary Mucinous Neoplasms ◽

Branch Duct ◽

Mucinous Neoplasms ◽

Cyst Growth

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Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis

Gut ◽

10.1136/gutjnl-2015-310162 ◽

2016 ◽

Vol 66 (3) ◽

pp. 495-506 ◽

Cited By ~ 107

Author(s):

Stefano Crippa ◽

Claudio Bassi ◽

Roberto Salvia ◽

Giuseppe Malleo ◽

Giovanni Marchegiani ◽

...

Keyword(s):

High Risk ◽

Operative Management ◽

Ductal Adenocarcinoma ◽

Intraductal Papillary Mucinous Neoplasms ◽

International Consensus ◽

Branch Duct ◽

Entire Cohort ◽

Mucinous Neoplasms ◽

International Consensus Guidelines

ObjectiveTo evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians’ recommendation, patient personal choice or comorbidities precluding surgery.MethodsIn this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (MD), the latter including mixed IPMNs. Univariate and multivariate analysis for overall survival (OS) and disease-specific survival (DSS) were obtained.ResultsOf 281 patients identified, 159 (57%) had BD-IPMNs and 122 (43%) had MD-IPMNs; 50 (18%) had high-risk stigmata and 231 (82%) had worrisome features. Median follow-up was 51 months. The 5-year OS and DSS for the entire cohort were 81% and 89.9%. An invasive pancreatic malignancy developed in 34 patients (12%); 31 had invasive IPMNs (11%) and 3 had IPMN-distinct pancreatic ductal adenocarcinoma (1%). Independent predictors of poor DSS in the entire cohort were age >70 years, atypical/malignant cyst fluid cytology, jaundice and MD >15 mm. Compared with MD-IPMNs, BD-IPMNs had significantly better 5-year OS (86% vs 74.1%, p=0.002) and DSS (97% vs 81.2%, p<0.0001). Patients with worrisome features had better 5-year DSS compared with those with high-risk stigmata (96.2% vs 60.2%, p<0.0001).ConclusionsIn elderly patients with IPMNs that have worrisome features, the 5-year DSS is 96%, suggesting that conservative management is appropriate. By contrast, presence of high-risk stigmata is associated with a 40% risk of IPMN-related death, reinforcing that surgical resection should be offered to fit patients.

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