Malignant progression and survival analysis for intraductal papillary mucinous neoplasms based on risk stratification

Abstract

Objective To evaluate the potential malignancy, prognosis and risk factors for intraductal papillary mucinous neoplasm (IPMN), which were classified into different risk levels based on Fukuoka guideline. Methods A retrospective analysis of patients with IPMN diagnosed at Nanjing Drum Tower Hospital from 2009 to 2016 was conducted. Clinical characteristics, treatment and prognosis of IPMNs were analyzed. Results A total of 94 IPMN patients were included and divided into 3 groups according to Fukuoka guideline, 46 patients in high-risk(HR) group, 30 in group of worrisome features (WF), and 18 in low-risk(LR) group. For patients undergoing surgery treatment, there were 5 cases (19.2%, 5/26) in HR group and 2 cases (12.5%, 2/16) in WF group whose postoperative pathological findings were malignant (P=0.690). The 5-year survival rates after operations were 73.9% and 77.0% in HR and WF group, respectively (P=0.830). For patients without surgery treatment, in a 5-year follow-up, there were 6 cases (33.3%, 6/18), 2 cases (16.7%, 2/12) and 0 (0.0%, 0/18) progressing into pancreatic cancers in HR, WF and LR groups, respectively (P<0.05). In addition, among the three groups, the 5-year survival rates were 49.5%, 85.7% and 100.0% (P=0.025). Jaundice was significantly related to prognosis (P<0.01) and the hazard ratio was 8.883 (95%CI: 2.953-26.721). Conclusion Jaundice is a predictive risk factor for survival of IPMN. As for the treatment to IPMN, patients in HR group should receive surgery treatment while those in LR group can be followed up. For patients in WF group, the treatment should be customized, with evaluation of predictive risk factors, and operations can be performed when needed. Key words: Prognosis; Jaundice; Intraductal papillary mucinous neoplasm; Risk stratification; Malignancy