Pancreatic Cancer is More Frequently Early Stage at Diagnosis in Surgically Resected Intraductal Papillary Mucinous Neoplasms With Preoperative Surveillance

Jaime de la Fuente; Jacob Lui; Ryan J. Lennon; Arjun Chatterjee; Rondell P. Graham; Lizhi Zhang; Michael L. Kendrick; Mark J. Truty; Sean P. Cleary; Rory L. Smoot; David M. Nagorney; Ferga C. Gleeson; Michael J. Levy; Vinay Chandrasekhara; Randall K. Pearson; Bret T. Petersen; Santhi S. Vege; Suresh T. Chari; Shounak Majumder

doi:10.1016/j.gastha.2022.07.004

Pancreatic Cancer is More Frequently Early Stage at Diagnosis in Surgically Resected Intraductal Papillary Mucinous Neoplasms With Preoperative Surveillance

Jaime de la Fuente, Jacob Lui, Ryan J. Lennon, Arjun Chatterjee, Rondell P. Graham, Lizhi Zhang, Michael L. Kendrick, Mark J. Truty, Sean P. Cleary, Rory L. Smoot, David M. Nagorney, Ferga C. Gleeson, Michael J. Levy, Vinay Chandrasekhara, Randall K. Pearson, Bret T. Petersen, Santhi S. Vege, Suresh T. Chari, Shounak Majumder

Research output: Contribution to journal › Article › peer-review

Abstract

Background and Aims: Management of intraductal papillary mucinous neoplasms (IPMNs) relies on clinical and imaging features to select patients for either pancreatectomy or periodic image-based surveillance. We aimed to compare outcomes in patients with IPMNs who underwent surgery at diagnosis with those who underwent surgery after a period of surveillance and identify preoperative clinical and imaging features associated with advanced neoplasia. Methods: Patients with surgically resected IPMN (n = 450) were divided into 2 groups: “immediate surgery”: resection within 6 months of IPMN detection, and “surveillance surgery”: resection after surveillance >6 months. Survival was analyzed with Kaplan-Meier estimates and Cox proportional hazard models. Results: Pancreatic cancers in the surveillance surgery group (n = 135) was more frequently stage I compared with the immediate surgery group (9/13, 69.2% vs 41/110, 37.3%; P =.027). Among Fukuoka “worrisome features,” only main pancreatic duct dilation 5–9 mm (odds ratio [OR] = 3.12, 95% confidence interval [CI]: 1.72–5.68; P <.001) and serum CA 19-9≥ 35 U/mL (OR = 2.82, 95% CI: 1.31–6.06; P =.008) were significantly associated with advanced neoplasia. In addition, smoking history was associated with increased risk of advanced neoplasia (OR = 2.05, 95% CI: 1.23–3.43). Occurrence of future cancer was 16-fold higher in IPMN with high-grade dysplasia when compared with low-grade dysplasia (hazard ratio: 16.5; 95% CI: 4.19–64.7). Conclusion: Surveillance-detected pancreatic cancers in patients with IPMNs are more frequently stage I, and IPMN-HGD on surgical pathology is associated with significant risk of future pancreatic cancer. In addition to known “high-risk” features, main pancreatic duct dilation 5–9 mm, CA 19-9 elevation, and smoking history are significantly associated with advanced neoplasia.

Original language	English (US)
Pages (from-to)	1099-1107
Number of pages	9
Journal	Gastro Hep Advances
Volume	1
Issue number	6
DOIs	https://doi.org/10.1016/j.gastha.2022.07.004
State	Published - Jan 2022

Keywords

Dysplasia
Intraductal Papillary Mucinous Neoplasm (IPMN)
Pancreatic Cancer
Surveillance

ASJC Scopus subject areas

Medicine (miscellaneous)
Gastroenterology
Hepatology

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10.1016/j.gastha.2022.07.004

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de la Fuente, J., Lui, J., Lennon, R. J., Chatterjee, A., Graham, R. P., Zhang, L., Kendrick, M. L., Truty, M. J., Cleary, S. P., Smoot, R. L., Nagorney, D. M., Gleeson, F. C., Levy, M. J., Chandrasekhara, V., Pearson, R. K., Petersen, B. T., Vege, S. S., Chari, S. T., & Majumder, S. (2022). Pancreatic Cancer is More Frequently Early Stage at Diagnosis in Surgically Resected Intraductal Papillary Mucinous Neoplasms With Preoperative Surveillance. Gastro Hep Advances, 1(6), 1099-1107. https://doi.org/10.1016/j.gastha.2022.07.004

de la Fuente, J, Lui, J, Lennon, RJ, Chatterjee, A, Graham, RP , Zhang, L, Kendrick, ML, Truty, MJ, Cleary, SP, Smoot, RL, Nagorney, DM, Gleeson, FC, Levy, MJ, Chandrasekhara, V, Pearson, RK, Petersen, BT , Vege, SS, Chari, ST & Majumder, S 2022, 'Pancreatic Cancer is More Frequently Early Stage at Diagnosis in Surgically Resected Intraductal Papillary Mucinous Neoplasms With Preoperative Surveillance', Gastro Hep Advances, vol. 1, no. 6, pp. 1099-1107. https://doi.org/10.1016/j.gastha.2022.07.004

@article{96053e96e8924b228d322eab7b9185b6,

title = "Pancreatic Cancer is More Frequently Early Stage at Diagnosis in Surgically Resected Intraductal Papillary Mucinous Neoplasms With Preoperative Surveillance",

abstract = "Background and Aims: Management of intraductal papillary mucinous neoplasms (IPMNs) relies on clinical and imaging features to select patients for either pancreatectomy or periodic image-based surveillance. We aimed to compare outcomes in patients with IPMNs who underwent surgery at diagnosis with those who underwent surgery after a period of surveillance and identify preoperative clinical and imaging features associated with advanced neoplasia. Methods: Patients with surgically resected IPMN (n = 450) were divided into 2 groups: “immediate surgery”: resection within 6 months of IPMN detection, and “surveillance surgery”: resection after surveillance >6 months. Survival was analyzed with Kaplan-Meier estimates and Cox proportional hazard models. Results: Pancreatic cancers in the surveillance surgery group (n = 135) was more frequently stage I compared with the immediate surgery group (9/13, 69.2% vs 41/110, 37.3%; P =.027). Among Fukuoka “worrisome features,” only main pancreatic duct dilation 5–9 mm (odds ratio [OR] = 3.12, 95% confidence interval [CI]: 1.72–5.68; P <.001) and serum CA 19-9≥ 35 U/mL (OR = 2.82, 95% CI: 1.31–6.06; P =.008) were significantly associated with advanced neoplasia. In addition, smoking history was associated with increased risk of advanced neoplasia (OR = 2.05, 95% CI: 1.23–3.43). Occurrence of future cancer was 16-fold higher in IPMN with high-grade dysplasia when compared with low-grade dysplasia (hazard ratio: 16.5; 95% CI: 4.19–64.7). Conclusion: Surveillance-detected pancreatic cancers in patients with IPMNs are more frequently stage I, and IPMN-HGD on surgical pathology is associated with significant risk of future pancreatic cancer. In addition to known “high-risk” features, main pancreatic duct dilation 5–9 mm, CA 19-9 elevation, and smoking history are significantly associated with advanced neoplasia.",

keywords = "Dysplasia, Intraductal Papillary Mucinous Neoplasm (IPMN), Pancreatic Cancer, Surveillance",

author = "{de la Fuente}, Jaime and Jacob Lui and Lennon, {Ryan J.} and Arjun Chatterjee and Graham, {Rondell P.} and Lizhi Zhang and Kendrick, {Michael L.} and Truty, {Mark J.} and Cleary, {Sean P.} and Smoot, {Rory L.} and Nagorney, {David M.} and Gleeson, {Ferga C.} and Levy, {Michael J.} and Vinay Chandrasekhara and Pearson, {Randall K.} and Petersen, {Bret T.} and Vege, {Santhi S.} and Chari, {Suresh T.} and Shounak Majumder",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = jan,

doi = "10.1016/j.gastha.2022.07.004",

language = "English (US)",

volume = "1",

pages = "1099--1107",

journal = "Gastro Hep Advances",

issn = "2772-5723",

publisher = "American Gastroenterological Association",

number = "6",

}

TY - JOUR

T1 - Pancreatic Cancer is More Frequently Early Stage at Diagnosis in Surgically Resected Intraductal Papillary Mucinous Neoplasms With Preoperative Surveillance

AU - de la Fuente, Jaime

AU - Lui, Jacob

AU - Lennon, Ryan J.

AU - Chatterjee, Arjun

AU - Graham, Rondell P.

AU - Zhang, Lizhi

AU - Kendrick, Michael L.

AU - Truty, Mark J.

AU - Cleary, Sean P.

AU - Smoot, Rory L.

AU - Nagorney, David M.

AU - Gleeson, Ferga C.

AU - Levy, Michael J.

AU - Chandrasekhara, Vinay

AU - Pearson, Randall K.

AU - Petersen, Bret T.

AU - Vege, Santhi S.

AU - Chari, Suresh T.

AU - Majumder, Shounak

PY - 2022/1

Y1 - 2022/1

N2 - Background and Aims: Management of intraductal papillary mucinous neoplasms (IPMNs) relies on clinical and imaging features to select patients for either pancreatectomy or periodic image-based surveillance. We aimed to compare outcomes in patients with IPMNs who underwent surgery at diagnosis with those who underwent surgery after a period of surveillance and identify preoperative clinical and imaging features associated with advanced neoplasia. Methods: Patients with surgically resected IPMN (n = 450) were divided into 2 groups: “immediate surgery”: resection within 6 months of IPMN detection, and “surveillance surgery”: resection after surveillance >6 months. Survival was analyzed with Kaplan-Meier estimates and Cox proportional hazard models. Results: Pancreatic cancers in the surveillance surgery group (n = 135) was more frequently stage I compared with the immediate surgery group (9/13, 69.2% vs 41/110, 37.3%; P =.027). Among Fukuoka “worrisome features,” only main pancreatic duct dilation 5–9 mm (odds ratio [OR] = 3.12, 95% confidence interval [CI]: 1.72–5.68; P <.001) and serum CA 19-9≥ 35 U/mL (OR = 2.82, 95% CI: 1.31–6.06; P =.008) were significantly associated with advanced neoplasia. In addition, smoking history was associated with increased risk of advanced neoplasia (OR = 2.05, 95% CI: 1.23–3.43). Occurrence of future cancer was 16-fold higher in IPMN with high-grade dysplasia when compared with low-grade dysplasia (hazard ratio: 16.5; 95% CI: 4.19–64.7). Conclusion: Surveillance-detected pancreatic cancers in patients with IPMNs are more frequently stage I, and IPMN-HGD on surgical pathology is associated with significant risk of future pancreatic cancer. In addition to known “high-risk” features, main pancreatic duct dilation 5–9 mm, CA 19-9 elevation, and smoking history are significantly associated with advanced neoplasia.

AB - Background and Aims: Management of intraductal papillary mucinous neoplasms (IPMNs) relies on clinical and imaging features to select patients for either pancreatectomy or periodic image-based surveillance. We aimed to compare outcomes in patients with IPMNs who underwent surgery at diagnosis with those who underwent surgery after a period of surveillance and identify preoperative clinical and imaging features associated with advanced neoplasia. Methods: Patients with surgically resected IPMN (n = 450) were divided into 2 groups: “immediate surgery”: resection within 6 months of IPMN detection, and “surveillance surgery”: resection after surveillance >6 months. Survival was analyzed with Kaplan-Meier estimates and Cox proportional hazard models. Results: Pancreatic cancers in the surveillance surgery group (n = 135) was more frequently stage I compared with the immediate surgery group (9/13, 69.2% vs 41/110, 37.3%; P =.027). Among Fukuoka “worrisome features,” only main pancreatic duct dilation 5–9 mm (odds ratio [OR] = 3.12, 95% confidence interval [CI]: 1.72–5.68; P <.001) and serum CA 19-9≥ 35 U/mL (OR = 2.82, 95% CI: 1.31–6.06; P =.008) were significantly associated with advanced neoplasia. In addition, smoking history was associated with increased risk of advanced neoplasia (OR = 2.05, 95% CI: 1.23–3.43). Occurrence of future cancer was 16-fold higher in IPMN with high-grade dysplasia when compared with low-grade dysplasia (hazard ratio: 16.5; 95% CI: 4.19–64.7). Conclusion: Surveillance-detected pancreatic cancers in patients with IPMNs are more frequently stage I, and IPMN-HGD on surgical pathology is associated with significant risk of future pancreatic cancer. In addition to known “high-risk” features, main pancreatic duct dilation 5–9 mm, CA 19-9 elevation, and smoking history are significantly associated with advanced neoplasia.

KW - Dysplasia

KW - Intraductal Papillary Mucinous Neoplasm (IPMN)

KW - Pancreatic Cancer

KW - Surveillance

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U2 - 10.1016/j.gastha.2022.07.004

DO - 10.1016/j.gastha.2022.07.004

M3 - Article

AN - SCOPUS:85173938521

SN - 2772-5723

VL - 1

SP - 1099

EP - 1107

JO - Gastro Hep Advances

JF - Gastro Hep Advances

IS - 6

ER -

Pancreatic Cancer is More Frequently Early Stage at Diagnosis in Surgically Resected Intraductal Papillary Mucinous Neoplasms With Preoperative Surveillance

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Keywords

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