Prognostic factors in resected high grade and invasive intraductal papillary mucinous neoplasm. Analysis of the national cancer database

Abstract

Objective: Consensus guidelines for management of IPMN primarily address the combined risk of specific lesions developing high grade dypsplasia or an invasive component. Long term prognosis of resected high grade and invasive IPMN remains unclear. We sought to determine factors associated with survival in these cases. Methods: We queried the NCDB from 2001–2006 for patients who underwent curative resection for high grade and invasive IPMN using ICD-O 3 codes. We evaluated the impact of demographic, facility, surgical and pathologic features on overall survival using Cox regression, univariate and multivariate analysis. P<0.05 was considered significant. Results: Of 581 patients who underwent surgery for invasive (n=263) and high grade (n=318) IPMN, increasing age (HR=1.04/year) and medicare (HR=1.35) vs private insurance status were negative prognostic indicators. Tumor features including increasing size, node positive disease, invasiveness, and margin status all negatively impacted survival (p<0.05). Median survival for high-grade disease was 10.11 years. Median survival for invasive disease was 5.17 for node negative disease and 1.41 years for node positive (p<0.01). Considering all patients, at multivariate analysis, only age, nodal status (HR: 4.24, CI: 2.97–6.04), and invasive disease (HR: 1.73, CI: 1.262.37) were associated with a worse outcome. Conclusion: Based on our analysis of high grade and invasive IPMN in patients undergoing resection, age, nodal status and degree of invasiveness were the most important prognostic indicators. Overall survival for high grade lesions and invasive lesions without nodal disease is surprisingly similar. Nodal disease however is a significant predictor of poor outcome and similar to resected pancreas cancer in general.