Abstract
Intraductal papillary mucinous neoplasms (IPMNs) are a heterogeneous group of neoplasms and represent the most common identifiable precursor lesions of pancreatic cancer. Clinical decision-making of the risk for malignant disease, including high-grade dysplasia and invasive carcinoma, is challenging. Moreover, discordance on the indication for resection exists between the contemporary guidelines. Furthermore, most of the current nomogram models for predicting malignant disease depend on endoscopic ultrasonography to evaluate the precise size of mural nodules. Thus, this study aimed to propose a model to predict malignant disease using variables from a noninvasive examination. We evaluated patients who underwent resection of pathologically confirmed IPMNs between November 2010 and December 2018 and had preoperative clinical data available for review. Based on binary multivariable logistic regression analysis, we devised a nomogram model to predict malignant IPMNs. The area under the receiver operating characteristics curve (AUC) was used to evaluate the discrimination power of the model. Of the 333 patients who underwent resection of IPMNs, 198 (59.5%) had benign and 135 (40.5%) had malignant IPMNs. Multivariable logistic regression analysis showed that cyst size, cyst location, cyst wall enhancement, multicystic lesion, diameter of main pancreatic duct, neutrophil-to-lymphocyte ratio, serum carbohydrate antigen 19-9, and carcinoembryonic antigen were significantly associated with malignancy. The nomogram, constructed based on these variables, showed excellent discrimination power with an AUC of 0.859 (95% CI: 0.818–0.900, P < 0.001). In conclusion, we have developed a nomogram consisting of a combination of cross-sectional imaging features and blood markers, variables that can readily be obtained by noninvasive examinations during the surveillance period, which can distinguish benign from malignant IPMNs. Nevertheless, external validation is warranted.
Highlights
Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are a heterogeneous group of lesions that grow within the ductal system of the pancreas [1]
Resection of precursor lesions, such as IPMNs, to prevent cancer could be an important method to improve the dismal prognosis of patients with pancreatic cancer
Risk–benefit outcomes of pancreatectomy with respect to perioperative morbidity and mortality and loss of endocrine and exocrine function would require a precise selection of patients whose IPMNs are at high risk of malignant transformation, considering the relatively dormant nature of most IPMNs, especially BDIPMNs
Summary
Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are a heterogeneous group of lesions that grow within the ductal system of the pancreas [1]. Interest in IPMNs is growing because of their frequent identification on routine crosssectional imaging and because they comprise the most common radiographically identifiable precursors of pancreatic carcinoma [2]. These cystic lesions are believed to progress from low-grade dysplasia (LGD), to high-grade dysplasia (HGD), and to invasive cancer and may involve the main pancreatic duct (MPD), branch ducts, or both [3]. Current recommendations for routine IPMNs resection have led both to overtreatment and to missed malignancy, including HGD and invasive disease, which in turn poses a considerable challenge among practitioners who are deciding between referring patients for aggressive surgical intervention or conservative surveillance. The risk of malignant degeneration must be balanced against the risks and benefits associated with definitive surgical management, patient comorbidities, and life expectancy [12]
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