Concomitant cancer at another site may be a new prognosticator in patients with branch duct intraductal papillary mucinous neoplasm who are not suitable candidates for surgical treatment
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: This study aimed to identify clinico-radiologic predictors factors for malignant transformation reflecting disease progression (PD) mainly defined by an interval increase in cyst size and alterations in morphology, in branch duct intraductal papillary mucinous neoplasm (BD-IPMN) patients with relatively long-term follow-up. Methods: This study analyzed 135 patients with BD-IPMN enrolled from July 2005 to October 2015, in whom a communication between the cystic lesion and the pancreatic duct was confirmed by endoscopic ultrasonography, magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography. Results: During a mean ± standard deviation follow-up period of 59.4 ± 29.2 months, PD was observed in 28 of 135 (20.7%) BD-IPMN patients. Eight patients (5.9%) displayed malignant transformation. In a univariate analysis, tumor location in the head and uncinate process, septate/multilocular cyst morphology, baseline cyst size ≥ 30 mm, an interval increase in cyst size, baseline cyst wall thickening ≥ 2 mm, baseline presence of mural nodules, and concomitant cancer at another site were significant predictive factors for malignant transformation in BD-IPMN patients. Cox forward stepwise linear regression revealed that a mural nodule (odds ratio [OR] = 58.210; 95% confidence interval [CI], 6.649–509.594; P < 0.01) and concomitant cancer at another site (OR = 8.463; 95% CI, 1.745–41.039; P < 0.01) were significant and independent predictors of malignant transformation in BD-IPMN patients. Conclusion: A considerable proportion of patients with BD-IPMN showed PD and malignant transformation during long-term follow-up. A mural nodule and concomitant cancer at another site were significant and independent predictive factors of malignant transformation in patients with BDIPMN.
Abstract
Background: This study aimed to identify clinico-radiologic predictors factors for malignant transformation reflecting disease progression (PD) mainly defined by an interval increase in cyst size and alterations in morphology, in branch duct intraductal papillary mucinous neoplasm (BD-IPMN) patients with relatively long-term follow-up. Methods: This study analyzed 135 patients with BD-IPMN enrolled from July 2005 to October 2015, in whom a communication between the cystic lesion and the pancreatic duct was confirmed by endoscopic ultrasonography, magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography. Results: During a mean ± standard deviation follow-up period of 59.4 ± 29.2 months, PD was observed in 28 of 135 (20.7%) BD-IPMN patients. Eight patients (5.9%) displayed malignant transformation. In a univariate analysis, tumor location in the head and uncinate process, septate/multilocular cyst morphology, baseline cyst size ≥ 30 mm, an interval increase in cyst size, baseline cyst wall thickening ≥ 2 mm, baseline presence of mural nodules, and concomitant cancer at another site were significant predictive factors for malignant transformation in BD-IPMN patients. Cox forward stepwise linear regression revealed that a mural nodule (odds ratio [OR] = 58.210; 95% confidence interval [CI], 6.649–509.594; P < 0.01) and concomitant cancer at another site (OR = 8.463; 95% CI, 1.745–41.039; P < 0.01) were significant and independent predictors of malignant transformation in BD-IPMN patients. Conclusion: A considerable proportion of patients with BD-IPMN showed PD and malignant transformation during long-term follow-up. A mural nodule and concomitant cancer at another site were significant and independent predictive factors of malignant transformation in patients with BDIPMN.
참고문헌 (28)
- Terris B, "Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct", Am J Surg Pathol, 24, pp.1372~1377 (2000)
- Tanaka M, "Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas", J Gastroenterol, 40, pp.669~675 (2005)
- Sohn TA, "Intraductal papillary mucinous neoplasms of the pancreas : an updated experience", Ann Surg, 239, pp.788~797 (2004)
- Rodriguez JR, "Branchduct intraductal papillary mucinous neoplasms : observations in 145 patients who underwent resection", Gastroenterology, 133, pp.72~79 (2007)
- Jang JY, "Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas : is it possible to predict the malignancy before surgery?", Ann Surg Oncol, 12, pp.124~132 (2005)
- Salvia R, "Branch-duct intraductal papillary mucinous neoplasms of the pancreas : to operate or not to operate?", Gut, 56, pp.1086~1090 (2007)
- Pelaez-Luna M, "Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients", Am J Gastroenterol, 102, pp.1759~1764 (2007)
- Tanaka M, "International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas", Pancreatology, 6, pp.17~32 (2006)
- Tanaka M, "International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas", Pancreatology, 12, pp.183~197 (2012)
- Nagai K, "Single-institution validation of the international consensus guidelines for treatment of branch duct intraductal papillary mucinous neoplasms of the pancreas", J Hepatobiliary Pancreat Surg, 16, pp.353~358 (2009)
- Maguchi H, "Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas : a multicenter study in Japan", Pancreas, 40, pp.364~370 (2011)
- Tanno S, "Natural history of branch duct intraductal papillary-mucinous neoplasms of the pancreas without mural nodules : long-term follow-up results", Gut, 57, pp.339~343 (2008)
- Woo SM, "Branch duct intraductal papillary mucinous neoplasms in a retrospective series of 190 patients", Br J Surg, 96, pp.405~411 (2009)
- Uehara H, "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, pp.657~663 (2011)
- Akita H, "Mural nodule in branch duct-type intraductal papillary mucinous neoplasms of the pancreas is a marker of malignant transformation and indication for surgery", Am J Surg, 202, pp.214~219 (2011)
- Jang JY, "Validation of international consensus guidelines for the resection of branch duct-type intraductal papillary mucinous neoplasms", Br J Surg, 101, pp.686~692 (2014)
- Adsay NV, "WHO classification of tumours of the digestive system", pp.304~313 (2010), IARC Press
- Sahora K, "Branch duct intraductal papillary mucinous neoplasms: does cyst size change the tip of the scale? A critical analysis of the revised international consensus guidelines in a large single-institutional series", Ann Surg, 258, pp.466~475 (2013)
- Cellier C, "Intraductal papillary and mucinous tumors of the pancreas : accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series", Gastrointest Endosc, 47, pp.42~49 (1998)
- Yamao K, "Evaluation of various imaging methods in the differential diagnosis of intraductal papillary-mucinous tumor(IPMT)of the pancreas", Hepatogastroenterology, 48, pp.962~966 (2001)
- Okabayashi T, "Clinicopathological features and medical management of intraductal papillary mucinous neoplasms", J Gastroenterol Hepatol, 21, pp.462~467 (2006)
- Kanno A, "Prediction of invasive carcinoma in branch type intraductal papillary mucinous neoplasms of the pancreas", J Gastroenterol, 45, pp.952~959 (2010)
- Kim KW, "Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas : a meta-analysis", Ann Surg, 259, pp.72~81 (2014)
- Uehara H, "Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas", Gut, 57, pp.1561~1565 (2008)
- Yamaguchi K, "Intraductal papillary neoplasm of the pancreas : a clinical review of 13 benign and four malignant tumours", Eur J Surg, 165, pp.223~229 (1999)
- Reid-Lombardo KM, "Frequency of extrapancreatic neoplasms in intraductal papillary mucinous neoplasm of the pancreas : implications for management", Ann Surg, 251, pp.64~69 (2010)
- Khan S, "Population-based epidemiology, risk factors and screening of intraductal papillary mucinous neoplasm patients", World J Gastrointest Surg, 2, pp.314~318 (2010)
- Kato T, "Malignant, but not benign, intraductal papillary mucinous neoplasm preferentially associates with prior extrapancreatic malignancies", Oncol Rep, 35, pp.3236~3240 (2016)