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Prognosis of resected intraductal papillary mucinous neoplasm of the pancreas: using revised 2017 international consensus guidelines

  • Pancreas
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Abstract

Purpose

Although there has been considerable effort to define pre-operative features to predict the malignant potential of intraductal papillary mucinous neoplasms (IPMNs), the prognostic value of pre-operative clinical and MRI features has not been assessed. The aim of this study was to determine pre-operative clinical and MRI features that are predictive of disease-specific death or recurrence in patients undergoing pancreatic resection for IPMNs.

Methods

We performed a retrospective analysis of 167 patients (mean age, 65 years; 114 men and 53 women) who underwent pre-operative MRI and surgical resection of IPMN of pancreas between 2009 and 2019. We evaluated disease-specific survival (DSS) and recurrence-free survival (RFS). Prognostic factor analysis was performed using clinical and MRI features according to the 2017 international consensus guidelines.

Results

Of 167 patients, 86 (51.5%) had benign IPMNs and 81 (48.5%) had malignant IPMNs (48 [28.7%] invasive carcinoma and 33 [19.8%] high grade). On multivariable analysis, mural nodule size (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.04–1.18 and HR 1.07; 95% CI 1.03–1.12) and obstructive jaundice (HR 5.01; 95% CI 1.44–17.46 and HR 5.60; 95% CI 2.42–12.99) were the significant variables that were associated with DSS and RFS. The presence of lymphadenopathy (HR 50.7; 95% CI 4.0–643.0; P = 0.002) was the significant factor for DSS. IPMNs with mural nodule showed a significantly lower 5-year DSS (83.7% vs. 100%, P value < 0.01) and RFS (73.1% vs. 95.0%, P value < 0.01) compared with IPMNs with no mural nodule.

Conclusions

Mural nodule size on MRI and obstructive jaundice were prognostic markers in the pre-operative evaluation of patients with IPMN of pancreas.

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Abbreviations

IPMN:

Intraductal papillary mucinous neoplasm

DSS:

Disease-specific survival

RFS:

Recurrence-free survival

HR:

Hazard ratio

CI:

Confidence interval

MPD:

Main pancreatic duct

BD:

Branch duct

MD:

Main duct

MRCP:

MR cholangiopancreatography

References

  1. Lim JH, Lee G, Oh YL (2001) Radiologic spectrum of intraductal papillary mucinous tumor of the pancreas. Radiographics 21:323–337; discussion 337–340. https://doi.org/10.1148/radiographics.21.2.g01mr01323.

  2. Adsay NV, Kloppel G, Fukushima N, Offerhaus GJA, Furukawa T, Pitman MB, Hruban RH, Shimizu M, Klimstra DS, Zamboni G (2010) Intraductal neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, eds. World Health Organization Classification of Tumors: Pathology and Genetics of Tumours of the Digestive System. 4th ed. Lyon, France: IARC Press, pp 304-313.

    Google Scholar 

  3. Basturk O, Hong SM, Wood LD, Adsay NV, Albores-Saavedra J, Biankin AV, Brosens LA, Fukushima N, Goggins M, Hruban RH, Kato Y, Klimstra DS, Klöppel G, Krasinskas A, Longnecker DS, Matthaei H, Offerhaus GJ, Shimizu M, Takaori K, Terris B, Yachida S, Esposito I, Furukawa T (2015) A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas. Am J Surg Pathol 39:1730-1741. https://doi.org/10.1097/pas.0000000000000533.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yamada S, Fujii T, Shimoyama Y, Kanda M, Nakayama G, Sugimoto H, Koike M, Nomoto S, Fujiwara M, Nakao A, Kodera Y (2014) Clinical implication of morphological subtypes in management of intraductal papillary mucinous neoplasm. Ann Surg Oncol 21:2444-2452. https://doi.org/10.1245/s10434-014-3565-1.

    Article  PubMed  Google Scholar 

  5. Poultsides GA, Reddy S, Cameron JL, Hruban RH, Pawlik TM, Ahuja N, Jain A, Edil BH, Iacobuzio-Donahue CA, Schulick RD, Wolfgang CL (2010) Histopathologic basis for the favorable survival after resection of intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma of the pancreas. Ann Surg 251:470-476. https://doi.org/10.1097/SLA.0b013e3181cf8a19.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, Yamaguchi K, Yamao K, Matsuno S (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17-32. https://doi.org/10.1159/000090023.

    Article  PubMed  Google Scholar 

  7. Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183-197. https://doi.org/10.1016/j.pan.2012.04.004.

    Article  PubMed  Google Scholar 

  8. Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, Salvia R, Shimizu Y, Tada M, Wolfgang CL (2017) Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 17:738-753. https://doi.org/10.1016/j.pan.2017.07.007.

    Article  PubMed  Google Scholar 

  9. Furukawa T, Hatori T, Fujita I, Yamamoto M, Kobayashi M, Ohike N, Morohoshi T, Egawa S, Unno M, Takao S, Osako M, Yonezawa S, Mino-Kenudson M, Lauwers GY, Yamaguchi H, Ban S, Shimizu M (2011) Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. Gut 60:509-516. https://doi.org/10.1136/gut.2010.210567.

    Article  PubMed  Google Scholar 

  10. Mino-Kenudson M, Fernandez-del Castillo C, Baba Y, Valsangkar NP, Liss AS, Hsu M, Correa-Gallego C, Ingkakul T, Perez Johnston R, Turner BG, Androutsopoulos V, Deshpande V, McGrath D, Sahani DV, Brugge WR, Ogino S, Pitman MB, Warshaw AL, Thayer SP (2011) Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut 60:1712-1720. https://doi.org/10.1136/gut.2010.232272.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Koh YX, Zheng HL, Chok AY, Tan CS, Wyone W, Lim TK, Tan DM, Goh BK (2015) Systematic review and meta-analysis of the spectrum and outcomes of different histologic subtypes of noninvasive and invasive intraductal papillary mucinous neoplasms. Surgery 157:496-509https://doi.org/10.1016/j.surg.2014.08.098.

    Article  PubMed  Google Scholar 

  12. Hwang J, Kim YK, Min JH, Jeong WK, Hong SS, Kim HJ (2018) Comparison between MRI with MR cholangiopancreatography and endoscopic ultrasonography for differentiating malignant from benign mucinous neoplasms of the pancreas. Eur Radiol 28:179-187. https://doi.org/10.1007/s00330-017-4926-5.

    Article  PubMed  Google Scholar 

  13. Lee JE, Choi SY, Min JH, Yi BH, Lee MH, Kim SS, Hwang JA, Kim JH (2019) Determining Malignant Potential of Intraductal Papillary Mucinous Neoplasm of the Pancreas: CT versus MRI by Using Revised 2017 International Consensus Guidelines. Radiology 293:134-143. https://doi.org/10.1148/radiol.2019190144.

    Article  PubMed  Google Scholar 

  14. Marchegiani G, Mino-Kenudson M, Ferrone CR, Morales-Oyarvide V, Warshaw AL, Lillemoe KD, Castillo CF (2015) Patterns of Recurrence After Resection of IPMN: Who, When, and How? Ann Surg 262:1108-1114. https://doi.org/10.1097/sla.0000000000001008.

    Article  PubMed  Google Scholar 

  15. Sugimoto M, Elliott IA, Nguyen AH, Kim S, Muthusamy VR, Watson R, Hines OJ, Dawson DW, Reber HA, Donahue TR (2017) Assessment of a Revised Management Strategy for Patients With Intraductal Papillary Mucinous Neoplasms Involving the Main Pancreatic Duct. JAMA Surg 152:e163349. https://doi.org/10.1001/jamasurg.2016.3349.

    Article  PubMed  Google Scholar 

  16. (2018) European evidence-based guidelines on pancreatic cystic neoplasms. Gut 67:789–804. https://doi.org/10.1136/gutjnl-2018-316027.

  17. Watanabe Y, Endo S, Nishihara K, Ueda K, Mine M, Tamiya S, Nakano T, Tanaka M (2018) The validity of the surgical indication for intraductal papillary mucinous neoplasm of the pancreas advocated by the 2017 revised International Association of Pancreatology consensus guidelines. Surg Today 48:1011-1019. https://doi.org/10.1007/s00595-018-1691-2.

    Article  PubMed  Google Scholar 

  18. Vanella G, Crippa S, Archibugi L, Arcidiacono PG, Delle Fave G, Falconi M, Capurso G (2018) Meta-analysis of mortality in patients with high-risk intraductal papillary mucinous neoplasms under observation. Br J Surg 105:328-338. https://doi.org/10.1002/bjs.10768.

    Article  CAS  PubMed  Google Scholar 

  19. Marchegiani G, Andrianello S, Borin A, Dal Borgo C, Perri G, Pollini T, Romano G, D'Onofrio M, Gabbrielli A, Scarpa A, Malleo G, Bassi C, Salvia R (2018) Systematic review, meta-analysis, and a high-volume center experience supporting the new role of mural nodules proposed by the updated 2017 international guidelines on IPMN of the pancreas. Surgery 163:1272-1279. https://doi.org/10.1016/j.surg.2018.01.009.

    Article  PubMed  Google Scholar 

  20. Uehara H, Ishikawa O, Katayama K, Kawada N, Ikezawa K, Fukutake N, Takakura R, Takano Y, Tanaka S, Takenaka A (2011) Size of mural nodule as an indicator of surgery for branch duct intraductal papillary mucinous neoplasm of the pancreas during follow-up. J Gastroenterol 46:657-663. https://doi.org/10.1007/s00535-010-0343-0.

    Article  PubMed  Google Scholar 

  21. Kim KW, Park SH, Pyo J, Yoon SH, Byun JH, Lee MG, Krajewski KM, Ramaiya NH (2014) Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Ann Surg 259:72-81.https://doi.org/10.1097/SLA.0b013e31829385f7.

    Article  PubMed  Google Scholar 

  22. Seo N, Byun JH, Kim JH, Kim HJ, Lee SS, Song KB, Kim SC, Han DJ, Hong SM, Lee MG (2016) Validation of the 2012 International Consensus Guidelines Using Computed Tomography and Magnetic Resonance Imaging: Branch Duct and Main Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas. Ann Surg 263:557-564.https://doi.org/10.1097/sla.0000000000001217.

    Article  PubMed  Google Scholar 

  23. Hackert T, Fritz S, Klauss M, Bergmann F, Hinz U, Strobel O, Schneider L, Buchler MW (2015) Main-duct Intraductal Papillary Mucinous Neoplasm: High Cancer Risk in Duct Diameter of 5 to 9 mm. Ann Surg 262:875–880; discussion 880–871. https://doi.org/10.1097/sla.0000000000001462.

  24. Del Chiaro M, Beckman R, Ateeb Z, Orsini N, Rezaee N, Manos L, Valente R, Yuan C, Ding D, Margonis GA, Yin L, Cameron JL, Makary MA, Burkhart RA, Weiss MJ, He J, Arnelo U, Yu J, Wolfgang CL (2019) Main Duct Dilatation Is the Best Predictor of High-grade Dysplasia or Invasion in Intraductal Papillary Mucinous Neoplasms of the Pancreas. Ann Surg. https://doi.org/10.1097/SLA.0000000000003174.

    Article  PubMed  Google Scholar 

  25. Ogura T, Masuda D, Kurisu Y, Edogawa S, Imoto A, Hayashi M, Uchiyama K, Higuchi K (2013) Potential predictors of disease progression for main-duct intraductal papillary mucinous neoplasms of the pancreas. J Gastroenterol Hepatol 28:1782-1786. https://doi.org/10.1111/jgh.12301.

    Article  PubMed  Google Scholar 

  26. Takuma K, Kamisawa T, Anjiki H, Egawa N, Kurata M, Honda G, Tsuruta K, Horiguchi S, Igarashi Y (2011) Predictors of malignancy and natural history of main-duct intraductal papillary mucinous neoplasms of the pancreas. Pancreas 40:371-375. https://doi.org/10.1097/MPA.0b013e3182056a83.

    Article  PubMed  Google Scholar 

  27. Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N, Campbell KA, Lillemoe KD (2004) Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 239:788–797; discussion 797–789. https://doi.org/10.1097/01.sla.0000128306.90650.aa.

  28. Kang HJ, Lee DH, Lee JM, Yoo J, Weiland E, Kim E, Son Y (2020) Clinical Feasibility of Abbreviated Magnetic Resonance With Breath-Hold 3-Dimensional Magnetic Resonance Cholangiopancreatography for Surveillance of Pancreatic Intraductal Papillary Mucinous Neoplasm. Invest Radiol 55:262-269. https://doi.org/10.1097/rli.0000000000000636.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea

    Ji Hye Min, Young Kon Kim, Honsoul Kim & Dong lk Cha

  2. Department of Mathematics, Ajou University, Suwon, Republic of Korea

    Soohyun Ahn

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  1. Ji Hye Min
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Correspondence to Young Kon Kim.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This retrospective study was approved by our institutional review board, and the requirement for informed consent was waived.

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Min, J.H., Kim, Y.K., Kim, H. et al. Prognosis of resected intraductal papillary mucinous neoplasm of the pancreas: using revised 2017 international consensus guidelines. Abdom Radiol 45, 4290–4301 (2020). https://doi.org/10.1007/s00261-020-02627-y

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