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. 2023 Oct 2;6(10):e2337799.
doi: 10.1001/jamanetworkopen.2023.37799.

Long-Term Outcomes and Risk of Pancreatic Cancer in Intraductal Papillary Mucinous Neoplasms

Jaime de la Fuente  1 , Arjun Chatterjee  2 , Jacob Lui  3 , Avinash K Nehra  4 , Matthew G Bell  5 , Ryan J Lennon  6 , Blake A Kassmeyer  6 , Rondell P Graham  7 , Hiroki Nagayama  4 , Phillip J Schulte  6 , Karen A Doering  1 , Adriana M Delgado  1 , Santhi Swaroop Vege  1 , Suresh T Chari  8 , Naoki Takahashi  4 , Shounak Majumder  1
Affiliations

Long-Term Outcomes and Risk of Pancreatic Cancer in Intraductal Papillary Mucinous Neoplasms

Jaime de la Fuente et al. JAMA Netw Open. .

Abstract

Importance: Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cysts that can give rise to pancreatic cancer (PC). Limited population data exist on their prevalence, natural history, or risk of malignant transformation (IPMN-PC).

Objective: To fill knowledge gaps in epidemiology of IPMNs and associated PC risk by estimating population prevalence of IPMNs, associated PC risk, and proportion of IPMN-PC.

Design, setting, and participants: : This retrospective cohort study was conducted in Olmsted County, Minnesota. Using the Rochester Epidemiology Project (REP), patients aged 50 years and older with abdominal computed tomography (CT) scans between 2000 and 2015 were randomly selected (CT cohort). All patients from the REP with PC between 2000 and 2019 were also selected (PC cohort). Data were analyzed from November 2021 through August 2023.

Main outcomes and measures: CIs for PC incidence estimates were calculated using exact methods with the Poisson distribution. Cox models were used to estimate age, sex, and stage-adjusted hazard ratios for time-to-event end points.

Results: The CT cohort included 2114 patients (1140 females [53.9%]; mean [SD] age, 68.6 [12.1] years). IPMNs were identified in 231 patients (10.9%; 95% CI, 9.7%-12.3%), most of which were branch duct (210 branch-duct [90.9%], 16 main-duct [6.9%], and 5 mixed [2.2%] IPMNs). There were 5 Fukuoka high-risk (F-HR) IPMNs (2.2%), 39 worrisome (F-W) IPMNs (16.9%), and 187 negative (F-N) IPMNs (81.0%). After a median (IQR) follow-up of 12.0 (8.1-15.3) years, 4 patients developed PC (2 patients in F-HR and 2 patients in F-N groups). The PC incidence rate per 100 person years for F-HR IPMNs was 34.06 incidents (95% CI, 4.12-123.02 incidents) and not significantly different for patients with F-N IPMNs compared with patients without IPMNs (0.16 patients; 95% CI, 0.02-0.57 patients vs 0.11 patients; 95% CI, 0.06-0.17 patients; P = .62). The PC cohort included 320 patients (155 females [48.4%]; mean [SD] age, 72.0 [12.3] years), and 9.8% (95% CI, 7.0%-13.7%) had IPMN-PC. Compared with 284 patients with non-IPMN PC, 31 patients with IPMN-PC were older (mean [SD] age, 76.9 [9.2] vs 71.3 [12.5] years; P = .02) and more likely to undergo surgical resection (14 patients [45.2%] vs 60 patients [21.1%]; P = .003) and more-frequently had nonmetastatic PC at diagnosis (20 patients [64.5%] vs 130 patients [46.8%]; P = .047). Patients with IPMN-PC had better survival (adjusted hazard ratio, 0.62; 95% CI, 0.40-0.94; P = .03) than patients with non-IPMN PC.

Conclusions and relevance: In this study, CTs identified IPMNs in approximately 10% of patients aged 50 years or older. PC risk in patients with F-N IPMNs was low and not different compared with patients without IPMNs; approximately 10% of patients with PC had IPMN-PC, and they had better survival compared with patients with non-IPMN PC.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Doering reported receiving a minority portion of compensation for licensed intellectual property from Exact Sciences paid to the Mayo Clinic outside the submitted work. Dr Majumder reported receiving grants from the Centene Charitable Foundation and National Cancer Institute during the conduct of the study and research support from Exact Sciences outside the submitted work and having patents pending for Exact Sciences. Mayo Clinic and Exact Sciences have an intellectual property development agreement, and Dr Majumder is listed as an inventor under this agreement and could share future royalties as an employee of Mayo Clinic. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart of Computed Tomography (CT) Cohort
REP indicates Rochester Epidemiology Project.
Figure 2.
Figure 2.. Prevalence of Intraductal Papillary Mucinous Neoplasms (IPMNs)
The prevalence of IPMNs using computed tomography is presented A, in each 4-year period of the study and B, in age group by decade.
Figure 3.
Figure 3.. Incidence of Pancreatic Cancer
Incidence curves for males and females of pancreatic cancer between the Fukuoka-negative (F-N) intraductal papillary mucinous neoplasm (IPMN) population and non-IPMN population. Patients entered the at-risk set according to their age at computed tomography.
Figure 4.
Figure 4.. Study Flowchart of Pancreatic Cancer (PC) Cohort
CA indicates cancer antigen; REP, Rochester Epidemiology Project.
Figure 5.
Figure 5.. Adjusted Survival in Pancreatic Cancer (PC) With and Without Intraductal Papillary Mucinous Neoplasm (IPMN)
Age, sex, and stage–adjusted survival in PC arising from IPMNs (IPMN-PC) and non-IPMN PC is presented. HR indicates hazard ratio.
See this image and copyright information in PMC

Comment in

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