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Disease-Specific Mortality Among Patients With Intraductal Papillary Mucinous Neoplasm of the Pancreas

2013; Elsevier BV; Volume: 12; Issue: 3 Linguagem: Inglês

10.1016/j.cgh.2013.06.032

1542-7714

Kazumichi Kawakubo, Minoru Tada, Hiroyuki Isayama, Naoki Sasahira, Yousuke Nakai, Naminatsu Takahara, Rie Uchino, Tsuyoshi Hamada, Koji Miyabayashi, Keisuke Yamamoto, Suguru Mizuno, Dai Mohri, Hirofumi Kogure, Takashi Sasaki, Natsuyo Yamamoto, Kenji Hirano, Hideaki Ijichi, Keisuke Tateishi, Kazuhiko Koike,

Gallbladder and Bile Duct Disorders

Background & AimsIntraductal papillary mucinous neoplasm (IPMN) of the pancreas is associated with synchronous and metachronous pancreatic cancer. However, the risk factors for pancreatic cancer–specific mortality have not been determined. We evaluated disease-specific mortality among patients with IPMNs harboring high-risk stigmata.MethodsWe analyzed data from 243 patients diagnosed with IPMN, with indications for surgery according to the consensus criteria, at the University of Tokyo Hospital from 1995 to January 2011. By using optimal matching and propensity scores based on 16 characteristics, we matched patients who underwent surgery at diagnosis with those who did not undergo surgery. A competing risk analysis was used to assess the risk of pancreatic cancer–specific mortality.ResultsFifty-nine patients underwent surgery after diagnosis and 184 did not. After adjustment with propensity scores, detection of a hypo-attenuating area by computed tomography, which indicates invasive carcinoma, was associated significantly with pancreatic cancer–specific mortality (adjusted hazard ratio, 16.75; 95% confidence interval, 2.72–103.3; P = .002). Cyst diameter, main pancreatic duct diameter, and the presence of a mural nodule were not associated significantly with pancreatic cancer–specific mortality. Surgical management was found to reduce pancreatic cancer–specific mortality, especially in patients with hypo-attenuating areas (P = .038).ConclusionsDetection of a hypo-attenuating area by computed tomography significantly increases the risk for pancreatic cancer–specific mortality among IPMN patients with consensus indications for surgery. Surgical resection significantly reduces this risk. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is associated with synchronous and metachronous pancreatic cancer. However, the risk factors for pancreatic cancer–specific mortality have not been determined. We evaluated disease-specific mortality among patients with IPMNs harboring high-risk stigmata. We analyzed data from 243 patients diagnosed with IPMN, with indications for surgery according to the consensus criteria, at the University of Tokyo Hospital from 1995 to January 2011. By using optimal matching and propensity scores based on 16 characteristics, we matched patients who underwent surgery at diagnosis with those who did not undergo surgery. A competing risk analysis was used to assess the risk of pancreatic cancer–specific mortality. Fifty-nine patients underwent surgery after diagnosis and 184 did not. After adjustment with propensity scores, detection of a hypo-attenuating area by computed tomography, which indicates invasive carcinoma, was associated significantly with pancreatic cancer–specific mortality (adjusted hazard ratio, 16.75; 95% confidence interval, 2.72–103.3; P = .002). Cyst diameter, main pancreatic duct diameter, and the presence of a mural nodule were not associated significantly with pancreatic cancer–specific mortality. Surgical management was found to reduce pancreatic cancer–specific mortality, especially in patients with hypo-attenuating areas (P = .038). Detection of a hypo-attenuating area by computed tomography significantly increases the risk for pancreatic cancer–specific mortality among IPMN patients with consensus indications for surgery. Surgical resection significantly reduces this risk.