Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: A mid-term follow-up analysis

Stefano Crippa, Claudio Bassi, Roberto Salvia, Giuseppe Malleo, Giovanni Marchegiani, Vinciane Rebours, Philippe Levy, Stefano Partelli, Shadeah L. Suleiman, Peter A. Banks, Nazir Ahmed, Suresh T Chari, Carlos Fernández-Del Castillo, Massimo Falconi

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Objective To evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians' recommendation, patient personal choice or comorbidities precluding surgery. Methods In this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (MD), the latter including mixed IPMNs. Univariate and multivariate analysis for overall survival (OS) and disease-specific survival (DSS) were obtained. Results Of 281 patients identified, 159 (57%) had BD-IPMNs and 122 (43%) had MD-IPMNs; 50 (18%) had high-risk stigmata and 231 (82%) had worrisome features. Median follow-up was 51 months. The 5-year OS and DSS for the entire cohort were 81% and 89.9%. An invasive pancreatic malignancy developed in 34 patients (12%); 31 had invasive IPMNs (11%) and 3 had IPMN-distinct pancreatic ductal adenocarcinoma (1%). Independent predictors of poor DSS in the entire cohort were age >70 years, atypical/malignant cyst fluid cytology, jaundice and MD >15 mm. Compared with MD-IPMNs, BD-IPMNs had significantly better 5-year OS (86% vs 74.1%, p=0.002) and DSS (97% vs 81.2%, p<0.0001). Patients with worrisome features had better 5-year DSS compared with those with high-risk stigmata (96.2% vs 60.2%, p<0.0001). Conclusions In elderly patients with IPMNs that have worrisome features, the 5-year DSS is 96%, suggesting that conservative management is appropriate. By contrast, presence of high-risk stigmata is associated with a 40% risk of IPMN-related death, reinforcing that surgical resection should be offered to fit patients.

Original languageEnglish (US)
Pages (from-to)495-506
Number of pages12
JournalGut
Volume66
Issue number3
DOIs
StatePublished - Mar 1 2017

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Christianity
Survival
Neoplasms
Cyst Fluid
Jaundice
Pancreatic Neoplasms
Cell Biology
Comorbidity
Adenocarcinoma
Multivariate Analysis

Keywords

  • pancreatic cancer
  • pancreatic surgery
  • Pancreatic tumours

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management : A mid-term follow-up analysis. / Crippa, Stefano; Bassi, Claudio; Salvia, Roberto; Malleo, Giuseppe; Marchegiani, Giovanni; Rebours, Vinciane; Levy, Philippe; Partelli, Stefano; Suleiman, Shadeah L.; Banks, Peter A.; Ahmed, Nazir; Chari, Suresh T; Fernández-Del Castillo, Carlos; Falconi, Massimo.

In: Gut, Vol. 66, No. 3, 01.03.2017, p. 495-506.

Research output: Contribution to journalArticle

Crippa, S, Bassi, C, Salvia, R, Malleo, G, Marchegiani, G, Rebours, V, Levy, P, Partelli, S, Suleiman, SL, Banks, PA, Ahmed, N, Chari, ST, Fernández-Del Castillo, C & Falconi, M 2017, 'Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: A mid-term follow-up analysis', Gut, vol. 66, no. 3, pp. 495-506. https://doi.org/10.1136/gutjnl-2015-310162
Crippa, Stefano ; Bassi, Claudio ; Salvia, Roberto ; Malleo, Giuseppe ; Marchegiani, Giovanni ; Rebours, Vinciane ; Levy, Philippe ; Partelli, Stefano ; Suleiman, Shadeah L. ; Banks, Peter A. ; Ahmed, Nazir ; Chari, Suresh T ; Fernández-Del Castillo, Carlos ; Falconi, Massimo. / Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management : A mid-term follow-up analysis. In: Gut. 2017 ; Vol. 66, No. 3. pp. 495-506.
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abstract = "Objective To evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians' recommendation, patient personal choice or comorbidities precluding surgery. Methods In this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (MD), the latter including mixed IPMNs. Univariate and multivariate analysis for overall survival (OS) and disease-specific survival (DSS) were obtained. Results Of 281 patients identified, 159 (57{\%}) had BD-IPMNs and 122 (43{\%}) had MD-IPMNs; 50 (18{\%}) had high-risk stigmata and 231 (82{\%}) had worrisome features. Median follow-up was 51 months. The 5-year OS and DSS for the entire cohort were 81{\%} and 89.9{\%}. An invasive pancreatic malignancy developed in 34 patients (12{\%}); 31 had invasive IPMNs (11{\%}) and 3 had IPMN-distinct pancreatic ductal adenocarcinoma (1{\%}). Independent predictors of poor DSS in the entire cohort were age >70 years, atypical/malignant cyst fluid cytology, jaundice and MD >15 mm. Compared with MD-IPMNs, BD-IPMNs had significantly better 5-year OS (86{\%} vs 74.1{\%}, p=0.002) and DSS (97{\%} vs 81.2{\%}, p<0.0001). Patients with worrisome features had better 5-year DSS compared with those with high-risk stigmata (96.2{\%} vs 60.2{\%}, p<0.0001). Conclusions In elderly patients with IPMNs that have worrisome features, the 5-year DSS is 96{\%}, suggesting that conservative management is appropriate. By contrast, presence of high-risk stigmata is associated with a 40{\%} risk of IPMN-related death, reinforcing that surgical resection should be offered to fit patients.",
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T1 - Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management

T2 - A mid-term follow-up analysis

AU - Crippa, Stefano

AU - Bassi, Claudio

AU - Salvia, Roberto

AU - Malleo, Giuseppe

AU - Marchegiani, Giovanni

AU - Rebours, Vinciane

AU - Levy, Philippe

AU - Partelli, Stefano

AU - Suleiman, Shadeah L.

AU - Banks, Peter A.

AU - Ahmed, Nazir

AU - Chari, Suresh T

AU - Fernández-Del Castillo, Carlos

AU - Falconi, Massimo

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objective To evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians' recommendation, patient personal choice or comorbidities precluding surgery. Methods In this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (MD), the latter including mixed IPMNs. Univariate and multivariate analysis for overall survival (OS) and disease-specific survival (DSS) were obtained. Results Of 281 patients identified, 159 (57%) had BD-IPMNs and 122 (43%) had MD-IPMNs; 50 (18%) had high-risk stigmata and 231 (82%) had worrisome features. Median follow-up was 51 months. The 5-year OS and DSS for the entire cohort were 81% and 89.9%. An invasive pancreatic malignancy developed in 34 patients (12%); 31 had invasive IPMNs (11%) and 3 had IPMN-distinct pancreatic ductal adenocarcinoma (1%). Independent predictors of poor DSS in the entire cohort were age >70 years, atypical/malignant cyst fluid cytology, jaundice and MD >15 mm. Compared with MD-IPMNs, BD-IPMNs had significantly better 5-year OS (86% vs 74.1%, p=0.002) and DSS (97% vs 81.2%, p<0.0001). Patients with worrisome features had better 5-year DSS compared with those with high-risk stigmata (96.2% vs 60.2%, p<0.0001). Conclusions In elderly patients with IPMNs that have worrisome features, the 5-year DSS is 96%, suggesting that conservative management is appropriate. By contrast, presence of high-risk stigmata is associated with a 40% risk of IPMN-related death, reinforcing that surgical resection should be offered to fit patients.

AB - Objective To evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians' recommendation, patient personal choice or comorbidities precluding surgery. Methods In this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (MD), the latter including mixed IPMNs. Univariate and multivariate analysis for overall survival (OS) and disease-specific survival (DSS) were obtained. Results Of 281 patients identified, 159 (57%) had BD-IPMNs and 122 (43%) had MD-IPMNs; 50 (18%) had high-risk stigmata and 231 (82%) had worrisome features. Median follow-up was 51 months. The 5-year OS and DSS for the entire cohort were 81% and 89.9%. An invasive pancreatic malignancy developed in 34 patients (12%); 31 had invasive IPMNs (11%) and 3 had IPMN-distinct pancreatic ductal adenocarcinoma (1%). Independent predictors of poor DSS in the entire cohort were age >70 years, atypical/malignant cyst fluid cytology, jaundice and MD >15 mm. Compared with MD-IPMNs, BD-IPMNs had significantly better 5-year OS (86% vs 74.1%, p=0.002) and DSS (97% vs 81.2%, p<0.0001). Patients with worrisome features had better 5-year DSS compared with those with high-risk stigmata (96.2% vs 60.2%, p<0.0001). Conclusions In elderly patients with IPMNs that have worrisome features, the 5-year DSS is 96%, suggesting that conservative management is appropriate. By contrast, presence of high-risk stigmata is associated with a 40% risk of IPMN-related death, reinforcing that surgical resection should be offered to fit patients.

KW - pancreatic cancer

KW - pancreatic surgery

KW - Pancreatic tumours

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