Int J Gastrointest Interv.  2023 Nov;12(4):176-182. 10.18528/ijgii230055.

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

• Kim NH
• Kim HJ

• KMID: 2547832
• DOI: http://doi.org/10.18528/ijgii230055

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.

Keyword

Branch duct intraductal papillary mucinous neoplasm; Concomitant cancer; Disease progression; Malignant transformation; Mural nodules