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Invasive, mixed-type intraductal papillary mucinous neoplasm: superior prognosis compared to invasive main-duct intraductal papillary mucinous neoplasm.
Surgery 2015; 158(4):937-44; discussion 944-5S

Abstract

PURPOSE

It is unclear whether the duct involvement subtypes of intraductal papillary mucinous neoplasm (IPMN), ie, main (MD), mixed (MT), and branch (BD), confer any survival advantage when invasive IPMN occurs. We hypothesized that invasive MT-IPMN was associated with a better prognosis than invasive MD-IPMN.

METHODS

A retrospective review of a prospectively maintained database was performed of patients who underwent resection for IPMN at a single academic institution from 1992 to 2014. Characterization of IPMN subtype was assessed on final operative pathology. Statistics included univariate analysis, Kaplan-Meier survival curves, and Cox regression for independent predictors of increased survival.

RESULTS

Of 390 patients eligible for study, 74 had invasive IPMN (IPMC). Of these, 71 patients had complete data and were included in the analysis (17 MD-IPMC, 39 MT-IPMC, and 15 BD-IPMC). Median follow-up was 20 months (range, 2-174). MT-IPMC was associated with significantly greater overall survival (OS) (47 months) compared with MD-IPMC (12 months) (P = .049), but not with BD-IPMC (44 months) (P = .67). Multivariate Cox regression yielded a family history of pancreatic cancer, absence of jaundice, N0 status, negative margins, absence of lymphovascular invasion, and MT subtype as independent predictors of greater OS (P = .035, .015, .013, .036, .045, .043, respectively). No characteristic of IPMN (including MD diameter, solid component/mural nodule) was predictive of OS.

CONCLUSION

MT-IPMC appeared to be associated with a greater OS compared with pure MD-IPMC. This begs the question of a different underlying biology of MT-IPMN and argues against classification of all main duct involved IPMN into a single category.

Authors+Show Affiliations

Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Electronic address: eceppa@iupui.edu.Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.Gastroenterology, Parkview Health System, Fort Wayne, IN.Department of Medicine, Division of Gastroenterology, Indiana University Hospital, Indianapolis, IN.Department of Medicine, Division of Gastroenterology, Indiana University Hospital, Indianapolis, IN.Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26173683

Citation

Ceppa, Eugene P., et al. "Invasive, Mixed-type Intraductal Papillary Mucinous Neoplasm: Superior Prognosis Compared to Invasive Main-duct Intraductal Papillary Mucinous Neoplasm." Surgery, vol. 158, no. 4, 2015, pp. 937-44; discussion 944-5.
Ceppa EP, Roch AM, Cioffi JL, et al. Invasive, mixed-type intraductal papillary mucinous neoplasm: superior prognosis compared to invasive main-duct intraductal papillary mucinous neoplasm. Surgery. 2015;158(4):937-44; discussion 944-5.
Ceppa, E. P., Roch, A. M., Cioffi, J. L., Sharma, N., Easler, J. J., DeWitt, J. M., ... Schmidt, C. M. (2015). Invasive, mixed-type intraductal papillary mucinous neoplasm: superior prognosis compared to invasive main-duct intraductal papillary mucinous neoplasm. Surgery, 158(4), pp. 937-44; discussion 944-5. doi:10.1016/j.surg.2015.06.003.
Ceppa EP, et al. Invasive, Mixed-type Intraductal Papillary Mucinous Neoplasm: Superior Prognosis Compared to Invasive Main-duct Intraductal Papillary Mucinous Neoplasm. Surgery. 2015;158(4):937-44; discussion 944-5. PubMed PMID: 26173683.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Invasive, mixed-type intraductal papillary mucinous neoplasm: superior prognosis compared to invasive main-duct intraductal papillary mucinous neoplasm. AU - Ceppa,Eugene P, AU - Roch,Alexandra M, AU - Cioffi,Jessica L, AU - Sharma,Neil, AU - Easler,Jeffrey J, AU - DeWitt,John M, AU - House,Michael G, AU - Zyromski,Nicholas J, AU - Nakeeb,Attila, AU - Schmidt,C Max, Y1 - 2015/07/11/ PY - 2015/02/14/received PY - 2015/05/01/revised PY - 2015/06/03/accepted PY - 2015/7/16/entrez PY - 2015/7/16/pubmed PY - 2015/12/15/medline SP - 937-44; discussion 944-5 JF - Surgery JO - Surgery VL - 158 IS - 4 N2 - PURPOSE: It is unclear whether the duct involvement subtypes of intraductal papillary mucinous neoplasm (IPMN), ie, main (MD), mixed (MT), and branch (BD), confer any survival advantage when invasive IPMN occurs. We hypothesized that invasive MT-IPMN was associated with a better prognosis than invasive MD-IPMN. METHODS: A retrospective review of a prospectively maintained database was performed of patients who underwent resection for IPMN at a single academic institution from 1992 to 2014. Characterization of IPMN subtype was assessed on final operative pathology. Statistics included univariate analysis, Kaplan-Meier survival curves, and Cox regression for independent predictors of increased survival. RESULTS: Of 390 patients eligible for study, 74 had invasive IPMN (IPMC). Of these, 71 patients had complete data and were included in the analysis (17 MD-IPMC, 39 MT-IPMC, and 15 BD-IPMC). Median follow-up was 20 months (range, 2-174). MT-IPMC was associated with significantly greater overall survival (OS) (47 months) compared with MD-IPMC (12 months) (P = .049), but not with BD-IPMC (44 months) (P = .67). Multivariate Cox regression yielded a family history of pancreatic cancer, absence of jaundice, N0 status, negative margins, absence of lymphovascular invasion, and MT subtype as independent predictors of greater OS (P = .035, .015, .013, .036, .045, .043, respectively). No characteristic of IPMN (including MD diameter, solid component/mural nodule) was predictive of OS. CONCLUSION: MT-IPMC appeared to be associated with a greater OS compared with pure MD-IPMC. This begs the question of a different underlying biology of MT-IPMN and argues against classification of all main duct involved IPMN into a single category. SN - 1532-7361 UR - https://www.unboundmedicine.com/medline/citation/26173683/Invasive_mixed_type_intraductal_papillary_mucinous_neoplasm:_superior_prognosis_compared_to_invasive_main_duct_intraductal_papillary_mucinous_neoplasm_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(15)00450-X DB - PRIME DP - Unbound Medicine ER -