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Observational Study of the Incidence of Pancreatic and Extrapancreatic Malignancies During Surveillance of Patients With Branch-duct Intraductal Papillary Mucinous Neoplasm

Malleo, Giuseppe MD*; Marchegiani, Giovanni MD*; Borin, Alex MD*; Capelli, Paola MD; Accordini, Federico MD*; Butturini, Giovanni PhD*; Pederzoli, Paolo MD*; Bassi, Claudio FRCS FACS*; Salvia, Roberto MD, PhD*

doi: 10.1097/SLA.0000000000000884
Original Articles

Objective: This observational analysis assessed the incidence of pancreatic and extrapancreatic malignancies in BD-IPMN patients.

Background: Previous studies showed that progression to malignancy of pancreatic branch-duct (BD) intraductal papillary mucinous neoplasm (IPMN) is infrequent and that extrapancreatic malignancies (EPMs) occur with unusual frequency in IPMN patients.

Methods: Patients observed from 2000 to 2012 and enrolled in a surveillance protocol according to the current guidelines were considered eligible for the study. Only patients with follow-up of more than 12 months were evaluated. The incidence of EPM was calculated only in patients who were free of them at the time of IPMN diagnosis. Data were compared with Italian cancer statistics. The standardized incidence ratios (SIRs) and the 5- and 10-year incidence rates were estimated.

Results: The study population consisted of 569 patients. At a median follow-up of 56 months, 9 patients developed a pancreatic malignancy. Of these, 5 were unresectable. The SIR was 9.21 [95% confidence interval (CI), 1.85–26.91] in males, and 11.94 (95% CI, 4.36–26.0) in females, with a 5-year cumulative incidence of 1.4%. The EPM incidence analysis was performed in 456 patients. Thirty EPMs developed during the follow-up. The SIR was 1.40 (95% CI, 0.72–2.45) in males and 1.37 (95% CI, 0.81–2.16) in females. The 5-year rate of developing any EPM was 5.7%.

Conclusions: BD-IPMN patients are at risk of pancreatic carcinogenesis. Although the 5-year incidence rate was as low as 1.4%, the surveillance protocol based on the current guidelines failed to identify a small subset of patients who progressed to advanced disease. Patients with BD-IPMN are not at risk of extrapancreatic carcinogenesis.

Supplemental Digital Content is Available in the Text.This observational study assessed the incidence of pancreatic and extrapancreatic neoplasms in patients with branch-duct intraductal papillary mucinous neoplasm enrolled in a surveillance protocol. Data were compared with Italian cancer statistics. At a median follow-up of 56 months, the incidence of pancreatic malignancies was increased by 9.21-fold in males and by 11.94-fold in females, with a 5-year cumulative incidence of 1.4%. Nine patients developed pancreatic malignancies; of these 5 were unresectable. The incidence of extrapancreatic malignancies was not greater than expected.

*Unit of Surgery B; and

Unit of Pathology, The Pancreas Institute, Departments of Surgery and Pathology, University of Verona Hospital Trust, Verona, Italy.

Reprints: Roberto Salvia, MD, PhD, Unit of Surgery B, The Pancreas Institute, Department of Surgery and Oncology, G.B. Rossi Hospital, University of Verona Hospital Trust, P.Le L.A. Scuro 10, 37134 Verona, Italy. E-mail: roberto.salvia@ospedaleuniverona.it.

Disclosure: Supported by the Italian Foundation for the Research on Pancreatic Diseases (FIMP) (to G.M.). The authors declare no conflicts of interest.

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