TY - JOUR
T1 - Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms
AU - Oyama, Hiroki
AU - Tada, Minoru
AU - Takagi, Kaoru
AU - Tateishi, Keisuke
AU - Hamada, Tsuyoshi
AU - Nakai, Yousuke
AU - Hakuta, Ryunosuke
AU - Ijichi, Hideaki
AU - Ishigaki, Kazunaga
AU - Kanai, Sachiko
AU - Kogure, Hirofumi
AU - Mizuno, Suguru
AU - Saito, Kei
AU - Saito, Tomotaka
AU - Sato, Tatsuya
AU - Suzuki, Tatsunori
AU - Takahara, Naminatsu
AU - Morishita, Yasuyuki
AU - Arita, Junichi
AU - Hasegawa, Kiyoshi
AU - Tanaka, Mariko
AU - Fukayama, Masashi
AU - Koike, Kazuhiko
N1 - Publisher Copyright:
© 2020 AGA Institute
PY - 2020/1
Y1 - 2020/1
N2 - 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.
AB - 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.
KW - Cohort
KW - Neoplasm
KW - Pancreatic Cancer
KW - Prognostic Factor
UR - http://www.scopus.com/inward/record.url?scp=85076056076&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2019.08.032
DO - 10.1053/j.gastro.2019.08.032
M3 - Article
C2 - 31473224
AN - SCOPUS:85076056076
SN - 0016-5085
VL - 158
SP - 226-237.e5
JO - Gastroenterology
JF - Gastroenterology
IS - 1
ER -
