Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome

Abstract

Objective: To define the natural history of resected intraductal papillary mucinous neoplasms (IPMN) of the pancreas and to identify clinical and pathologic prognostic features.

Summary background data: IPMN of the pancreas is a recently described pancreatic tumor. Because of a limited number of cases, prognostic factors and the natural history of resected cases have not been well defined.

Materials and methods: A prospective pancreatic database was reviewed to identify patients with IPMN who were surgically managed. Pathologic re-review of each case was performed, and the clinicopathologic features were examined. Log rank and chi2 analysis were used to identify factors predictive of survival and recurrence.

Results: Over a 17-year period, 63 patients were identified. One patient was unresectable, 6 (10%) underwent a total pancreatectomy, and 56 (89%) had a partial pancreatectomy. Invasive carcinoma was present in 30 patients (48%). Transection margins were involved with atypia or carcinoma in 32 patients (51%). The median follow-up for survivors was 38 months. Disease-specific 5- and 10-year survival were 75% and 60%, respectively. Significant predictors of poor outcome included presentation with elevated bilirubin, presence of invasive carcinoma, increasing size and percentage of invasive carcinoma, histologic type of invasive carcinoma, positive lymph nodes, and vascular invasion. The presence of atypia or carcinoma in situ at the ductal resection margin was not associated with a poor outcome.

Conclusions: Overall, IPMN has a favorable prognosis. Poor outcome in a subset of patients is largely the result of the presence, extent, and type of an invasive component, lymph node metastases, and vascular invasion.

FIGURE 1. Kaplan–Meier actuarial disease-specific survival curve of 62 patients who had complete resection.

FIGURE 2. Kaplan–Meier actuarial disease-specific survival curves of (A) noninvasive (——) versus invasive (- - - -) disease and (B) noninvasive (——) versus invasive colloid carcinoma (- - - -) versus invasive tubular carcinoma (— - —).

FIGURE 3. Kaplan–Meier actuarial disease-specific survival curves of patients with noninvasive disease and uninvolved lymph nodes (——), invasive disease with uninvolved lymph nodes (- - - -), and invasive disease with involved lymph nodes (— - —).