Invasive, mixed-type intraductal papillary mucinous neoplasm: Superior prognosis compared to invasive main-duct intraductal papillary mucinous neoplasm

Eugene P. Ceppa, Alexandra M. Roch, Jessica L. Cioffi, Neil Sharma, Jeffrey J. Easler, John DeWitt, Michael House, Nicholas Zyromski, Attila Nakeeb, C. Schmidt

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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.

Original languageEnglish
Pages (from-to)937-945
Number of pages9
JournalSurgery
Volume158
Issue number4
DOIs
StatePublished - Oct 1 2015

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Neoplasms
Survival
Kaplan-Meier Estimate
Jaundice
Pancreatic Neoplasms
Databases
Pathology

ASJC Scopus subject areas

  • Surgery

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Invasive, mixed-type intraductal papillary mucinous neoplasm : Superior prognosis compared to invasive main-duct intraductal papillary mucinous neoplasm. / Ceppa, Eugene P.; Roch, Alexandra M.; Cioffi, Jessica L.; Sharma, Neil; Easler, Jeffrey J.; DeWitt, John; House, Michael; Zyromski, Nicholas; Nakeeb, Attila; Schmidt, C.

In: Surgery, Vol. 158, No. 4, 01.10.2015, p. 937-945.

Research output: Contribution to journalArticle

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title = "Invasive, mixed-type intraductal papillary mucinous neoplasm: Superior prognosis compared to invasive main-duct intraductal papillary mucinous neoplasm",
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.",
author = "Ceppa, {Eugene P.} and Roch, {Alexandra M.} and Cioffi, {Jessica L.} and Neil Sharma and Easler, {Jeffrey J.} and John DeWitt and Michael House and Nicholas Zyromski and Attila Nakeeb and C. Schmidt",
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T1 - Invasive, mixed-type intraductal papillary mucinous neoplasm

T2 - 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

AU - House, Michael

AU - Zyromski, Nicholas

AU - Nakeeb, Attila

AU - Schmidt, C.

PY - 2015/10/1

Y1 - 2015/10/1

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.

AB - 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.

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