Pancreatic cancer is more frequently early stage at diagnosis in surgically resected IPMNs with pre-operative surveillance
Jaime de la Fuente, Jacob Lui, Ryan J. Lennon, Arjun Chatterjee, Rondell P. Graham, Lizhi Zhang, Michael L. Kendrick, Mark J. Truty, Sean P. Cleary, Rory L. Smoot, David M. Nagorney, Ferga C. Gleeson, Michael J. Levy, Vinay Chandrasekhara, Randall K.Pearson, Bret T. Petersen, Santhi S. Vege, Suresh T. Chari, Shounak Majumder
Introduction: Management of intraductal papillary mucinous neoplasms (IPMNs) relies on clinical and imaging features to select patients for either pancreatectomy or periodic image-based surveillance. We aimed to compare outcomes in patients with IPMNs who underwent surgery at diagnosis with those who underwent surgery after a period of surveillance and identify pre-operative clinical and imaging features associated with advanced neoplasia.
Methods: Patients with surgically resected IPMN (n=450) were divided into two groups: “Immediate Surgery” (IS): resection within 6 months of IPMN detection, and “Surveillance Surgery” (SS): resection after surveillance > 6 months. Survival was analyzed with Kaplan-Meier estimates and Cox proportional hazard models.
Results: Pancreatic cancers in the SS group (n=135) was more frequently stage I compared to the IS group (9/13, 69.2% vs. 41/110, 37.3%; p=0.027). Among Fukuoka ‘worrisome features’, only main pancreatic duct (MPD) dilation 5-9mm (OR=3.12, 95% CI 1.72-5.68, p<0.001), and serum CA 19-9≥ 35 U/ml (OR=2.82, 95% CI 1.31-6.06, p=0.008) were significantly associated with advanced neoplasia. In addition, smoking history was associated with increased risk of advanced neoplasia (OR= 2.05, 95% CI: 1.23-3.43). Occurrence of future cancer was 16-fold higher in IPMN with high grade dysplasia when compared to low grade dysplasia (HR 16.5; 95% CI: 4.19-64.7).
Conclusion: Surveillance-detected pancreatic cancers in patients with IPMNs are more frequently Stage I and IPMN-HGD on surgical pathology is associated with significant risk of future pancreatic cancer. In addition to known ‘high-risk’ features, MPD dilation 5-9 mm, CA 19-9 elevation and smoking history are significantly associated with advanced neoplasia.
Read Full Article Here: https://doi.org/10.1016/j.gastha.2022.07.004