Effect of T wist and B mi1 on intraductal papillary mucinous neoplasm of the pancreas

Background Intraductal papillary mucinous neoplasm ( IPMN ) is a well‐established entity among pancreatic neoplasms that ranges from low‐grade dysplasia to invasive carcinoma. Epithelial‐mesenchymal transition ( EMT ) contributes to tumor progression in various cancers. Moreover, N otch signaling is one of the important upstream effectors of EMT promotion. Currently, it is unclear whether EMT causes pathological progression of IPMN . Aim We evaluated the expression of EMT ‐promoting transcription factors T wist and B cell‐specific M oloney murine leukemia virus insertion site 1 ( B mi1) in IPMN . Methods Patients who underwent resections at our institute and its affiliated hospital were enrolled in this study ( n  = 35). Protein expression of EMT markers T wist, B mi1, J agged1, and E ‐cadherin in resected specimens was investigated by immunohistochemistry. Expression of these proteins was compared with the clinicopathological factors and patient survival. Results Positive expression of T wist and B mi1 was observed in 40.0% and 42.9% of IPMNs , respectively. T wist and B mi1 expression was significantly higher in IPMN s with high‐grade dysplasia ( P  < 0.05) and invasive carcinoma ( P  < 0.05) than that in IPMN s with low‐grade dysplasia. High expression of T wist was correlated with J agged1 expression and inversely correlated with expression of E ‐cadherin ( P  = 0.06 and P  < 0.05, respectively). In survival analyses, the recurrence rate was significantly higher in the group that showed simultaneous high expression of T wist and B mi1 ( P  < 0.05). Conclusions Expression of T wist and B mi1 is associated with aggressiveness and poor prognoses of IPMN through EMT promotion that might be induced by N otch signaling.