P-171 - Risk Factors of Progression or Malignancy in Main Duct and Mixed-type Intraductal Papillary Mucinous Neoplasm of the Pancreas

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Cancer Aetiology, Epidemiology, Prevention
Pancreatic Cancer
Presenter S.H. Lee
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors S.H. Lee1, J. Ryu2, Y.-. Kim1, D.K. Jang1
  • 1Seoul National University College of Medicine, Seoul/KR
  • 2Seoul National University Hospital, Seoul/KR

Abstract

Introduction

According to the 2012 international guidelines, surgery should be considered in all surgically fit patients with main-duct (MD)/mixed intraductal papillary mucinous neoplasms (IPMNs). The aim of this study was to evaluate the follow-up results of MD/mixed IPMNs regardless of surgery and to seek risk factors of progression or malignancy in them.

Methods

Patients diagnosed with MD/mixed IPMNs at Seoul National University Hospital between Jan 2004 and June 2014 were retrospectively enrolled. Those who had follow-up duration of < 6 months and initial unresectable or invasive features were excluded. The included patients were divided into surgery and non-surgery group according to the treatment strategies. “Progression” in the non-surgery group was defined as either growth or invasive transformation radiologically during follow-up.

Results

A total of 101 patients (73 males, mean age of 66.3 ± 9.1 years) composed of 27 (26.7%) non-surgery and 74 (73.3%) surgery patients were included. On the whole, the two groups had similar clinical characteristics except presence of mural nodules (7.4% vs. 31.1%, P = 0.018), and multifocality (40.7% vs. 20.3%, P = 0.037). Forty-one (40.6%) patients showed either progression or malignancy, and each group had only one death during follow-up. The median time to progression was 62.0 months in the non-surgery group. Two factors, MPD ≥ 10 mm (OR, 4.368; 95% CI, 1.216-15.689; P = 0.024) and pre-existing diabetes (OR, 3.077; 95% CI, 1.019-9.294; P = 0.046), were determined as independent risk factors of progression or malignancy in the multivariate analysis.

Conclusion

This study suggests that watchful waiting strategy could be possible in some patients with MD/mixed IPMNs, particularly who are non-diabetic, with MPD < 10 mm.