Malignant potential and specific characteristics of pure main duct type intraductal papillary mucinous neoplasm |
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| Institution: | 1. Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan;2. Department of Pathology, Japanese Red Cross Kyoto Daiichi Hospital, Japan;1. Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, Schiedam, the Netherlands;2. Department of Surgery, division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands;3. Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands;4. Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands;5. Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands;6. Department of Surgery, division of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands;1. Department of Nuclear Medicine, Tata Memorial Hospital and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, 400012, India;2. Division of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India;3. Department of Medical Gastroenterology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India;4. Department of Radiation Oncology, Tata Memorial, Hospital and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, 400012, India;1. Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, UK;2. Institute of Immunology and Immunotherapy, University of Birmingham, UK;3. Institute of Cancer and Genomic Science, University of Birmingham, UK;4. Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, UK;5. Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;6. Department of Pathology, San Bortolo Hospital, Vicenza, Italy;1. Fiona Stanley Hospital, Western Australia, Australia;2. Department of General Surgery, St. James''s Hospital, Dublin 8, Ireland;3. Peter MacCallum Cancer Centre, Melbourne, Australia;4. Department of Urology, Tallaght University Hospital, Dublin 24, Ireland;5. Department of Surgery, University College London, London, UK;6. Altnagelvin Hospital, Derry, Northern Ireland, UK;1. Division of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India;2. Department Radiodiagnosis, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India;3. Department of Medical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India;1. Washington Cancer Institute, Program in Peritoneal Surface Malignancy Washington, DC, USA;2. Westat, Rockville, MD, USA |
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| Abstract: | BackgroundAs the malignant potential of main duct (MD-) type intraductal papillary mucinous neoplasm (IPMN) has been discussed together with Mixed-type in most previous studies, the malignant potential of pure MD-type IPMN remains unclear. This study evaluated the specific characteristics and predictors of high-grade dysplasia (HGD) and invasive intraductal papillary mucinous carcinoma (IPMC) for pure MD-type IPMN.MethodsFrom 1,100 patients with IPMN, this study includes 387 patients that underwent surgery. We evaluated the specific characteristics of pure MD-type IPMN by comparing clinicopathological factors between MD-type (n = 79) and branch duct (BD-) type (n = 146) or Mixed-type IPMN (n = 162), and predictors of HGD/invasive IPMC in pure MD-type IPMN.ResultsThe rate of HGD/invasive IPMC was significantly higher in MD-type than in BD-type (70.9 vs. 48.6%, P = 0.001), although there was no difference between MD-type and Mixed-type IPMNs (P = 0.343). Recurrence-free survival (RFS) and disease-specific survival (DSS) of patients with MD-type were better than those of patients with Mixed-type (P = 0.008 and P = 0.009, respectively). There were no significant differences in RFS, overall survival, and DSS between patients with MD-type and patients with BD-type IPMNs. Multivariate analysis showed two independent predictors of HGD/invasive IPMC in MD-type IPMN; mural nodule height ≥5 mm (P = 0.025, odds ratio OR]; 16.949) and carcinoembryonic antigen (CEA) level in the pancreatic juice obtained by preoperative endoscopic retrograde pancreatography ≥50 ng/ml (P = 0.039, OR; 9.091).ConclusionsMeasurement of mural nodule height and CEA in the pancreatic juice might be useful in determining surgical indication for pure MD-type IPMN, although further studies for confirmation are essential. |
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| Keywords: | IPMN Main duct type Malignant potential Operative indication Mural nodule height CEA in Pancreatic juice Category: original article |
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