Gastro Hep Advances (Jan 2022)

Pancreatic Cancer is More Frequently Early Stage at Diagnosis in Surgically Resected Intraductal Papillary Mucinous Neoplasms With Preoperative Surveillance

  • J. de la Fuente,
  • Jacob Lui,
  • Ryan J. Lennon,
  • Arjun Chatterjee,
  • Rondell P. Graham,
  • Lizhi Zhang,
  • Michael L. Kendrick,
  • Mark J. Truty,
  • Sean P. Cleary,
  • Rory L. Smoot,
  • David M. Nagorney,
  • Ferga C. Gleeson,
  • Michael J. Levy,
  • Vinay Chandrasekhara,
  • Randall K. Pearson,
  • Bret T. Petersen,
  • Santhi S. Vege,
  • Suresh T. Chari,
  • Shounak Majumder

Journal volume & issue
Vol. 1, no. 6
pp. 1099 – 1107

Abstract

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Background and Aims: Management of intraductal papillary mucinous neoplasms (IPMNs) relies on clinical and imaging features to select patients for either pancreatectomy or periodic image-based surveillance. We aimed to compare outcomes in patients with IPMNs who underwent surgery at diagnosis with those who underwent surgery after a period of surveillance and identify preoperative clinical and imaging features associated with advanced neoplasia. Methods: Patients with surgically resected IPMN (n = 450) were divided into 2 groups: “immediate surgery”: resection within 6 months of IPMN detection, and “surveillance surgery”: resection after surveillance >6 months. Survival was analyzed with Kaplan-Meier estimates and Cox proportional hazard models. Results: Pancreatic cancers in the surveillance surgery group (n = 135) was more frequently stage I compared with the immediate surgery group (9/13, 69.2% vs 41/110, 37.3%; P = .027). Among Fukuoka “worrisome features,” only main pancreatic duct dilation 5–9 mm (odds ratio [OR] = 3.12, 95% confidence interval [CI]: 1.72–5.68; P < .001) and serum CA 19-9≥ 35 U/mL (OR = 2.82, 95% CI: 1.31–6.06; P = .008) were significantly associated with advanced neoplasia. In addition, smoking history was associated with increased risk of advanced neoplasia (OR = 2.05, 95% CI: 1.23–3.43). Occurrence of future cancer was 16-fold higher in IPMN with high-grade dysplasia when compared with low-grade dysplasia (hazard ratio: 16.5; 95% CI: 4.19–64.7). Conclusion: Surveillance-detected pancreatic cancers in patients with IPMNs are more frequently stage I, and IPMN-HGD on surgical pathology is associated with significant risk of future pancreatic cancer. In addition to known “high-risk” features, main pancreatic duct dilation 5–9 mm, CA 19-9 elevation, and smoking history are significantly associated with advanced neoplasia.

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