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Potential predictors of disease progression for main‐duct intraductal papillary mucinous neoplasms of the pancreas
Author(s) -
Ogura Takeshi,
Masuda Daisuke,
Kurisu Yoshitaka,
Edogawa Shoko,
Imoto Akira,
Hayashi Michihiro,
Uchiyama Kazuhisa,
Higuchi Kazuhide
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12301
Subject(s) - medicine , hazard ratio , gastroenterology , malignancy , intraductal papillary mucinous neoplasm , univariate analysis , pancreatic duct , pancreas , confidence interval , surgery , radiology , multivariate analysis
Background and Aim The evidence for main pancreatic duct intraductal papillary mucinous neoplasms ( MPD ‐ IPMN ) malignancy is based predominantly on investigation of resected cases, and the natural history is still unclear. The aim of the present study is to investigate the natural history of MPD ‐ IPMN and examine potential predictors of disease progression in MPD ‐ IPMN patients who conformed to “high‐risk stigmata” criteria. Methods This study included consecutive 20 follow‐up patients and 19 surgical patients with “high‐risk stigmata” MPD ‐ IPMN , in whom the diameter of the MPD was > 10 mm, branch duct was < 5 mm, and who underwent clinical follow up for ≥ 2 years. Results Among surgical patients, mural nodules and MPD diameter of invasive patients were significantly different compared with non‐invasive patients. On the other hand, among follow‐up patients, univariate analysis revealed the following potential predictors for disease progression: diameter of MPD ≥ 15 mm (hazard ratio [ HR ], 20.9; 95% confidence interval [ CI ], 2.59–173.4; P < 0.01); and diffuse lesions of MPD ‐ IPMN ( HR , 4.46; 95% CI , 1.10–18.0; P = 0.04). On the other hand, multivariate analysis identified only diameter of MPD ≥ 15 mm ( HR , 19.2; 95% CI , 1.87–198.5; P = 0.01) as a potential predictor of disease progression. Conclusion If MPD ‐ IPMN patients have other severe complications or reasons for not undergoing surgical treatment, MPD diameter < 15 mm, negative cytology, and no mural nodules, conservative clinical follow up for several years may be an option.