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Pancreas
Paper
Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas
  1. Toru Furukawa1,2,
  2. Takashi Hatori3,
  3. Izumi Fujita3,
  4. Masakazu Yamamoto3,
  5. Makio Kobayashi2,4,
  6. Nobuyuki Ohike5,
  7. Toshio Morohoshi5,
  8. Shinichi Egawa6,
  9. Michiaki Unno6,
  10. Sonshin Takao7,
  11. Masahiko Osako8,
  12. Suguru Yonezawa9,
  13. Mari Mino-Kenudson10,
  14. Gregory Y Lauwers10,
  15. Hiroshi Yamaguchi11,
  16. Shinichi Ban11,
  17. Michio Shimizu11
  1. 1Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
  2. 2Department of Surgical Pathology, Tokyo Women's Medical University Hospital, Tokyo, Japan
  3. 3Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
  4. 4Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
  5. 5First Department of Pathology, Showa University School of Medicine, Tokyo, Japan
  6. 6Division of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
  7. 7Frontier Science Research Center, Kagoshima University, Kagoshima, Japan
  8. 8Department of Surgery, Kagoshima-shi Medical Association Hospital, Kagoshima, Japan
  9. 9Department of Human Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
  10. 10Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
  11. 11Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
  1. Correspondence to Toru Furukawa, Institute for Integrated Medical Sciences, Tokyo Women's Medical University 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; toru.furukawa{at}twmu.ac.jp

Abstract

Objective The clinicopathological significance of four morphological types of intraductal papillary mucinous neoplasms of the pancreas (IPMNs; gastric, intestinal, pancreatobiliary and oncocytic) was assessed.

Design Retrospective multicentre analysis of 283 surgically resected IPMNs.

Results Of the 283 IPMNs, 139 were of the gastric type, 101 were intestinal, 19 were pancreatobiliary and 24 were oncocytic. These types were significantly associated with clinicopathological factors including sex (p=0.0032), age (p=0.00924), ectatic duct size (p=0.0245), detection of mural nodules (p=4.09×10−6), histological grade (p<2.20×10−16), macroscopic types with differential involvement of the pancreatic duct system (p=3.91×10−5), invasive phenotypes (p=3.34×10−12), stage (p<2.20×10−16) and recurrence (p=0.00574). Kaplan–Meier analysis showed significant differences in patient survival by morphological type (p=5.24×10−6). Survival rates at 5 and 10 years, respectively, were 0.937 (95% CI 0.892 to 0.984) for patients with gastric-type IPMNs; 0.886 (95% CI 0.813 to 0.965) and 0.685 (95% CI 0.553 to 0.849) for those with intestinal-type IPMNs; 0.839 (95% CI 0.684 to 1.000) and 0.734 (95% CI 0.526 to 1.000) for those with oncocytic-type IPMNs; and 0.520 (95% CI 0.298 to 0.909) and undetermined for those with pancreatobiliary-type IPMNs. Analysis by the Cox proportional hazards model comparing prognostic risks determined by stage and the morphological and macroscopic types indicated that staging was the most significant predictor of survival (p=3.68×10−8) followed by the morphological type (p=0.0435). Furthermore, the morphological type remained a significant predictor in a subcohort of invasive cases (p=0.0089).

Conclusion In this multicentre retrospective analysis, the morphological type of IPMN appears to be an independent predictor of patient prognosis.

  • IPMN
  • subtype
  • prognosis
  • clinicopathologic feature
  • pancreatic cancer
  • pancreatic pathology
  • pancreatic surgery
  • pancreatic tumours

http://dx.doi.org/10.1136/gut.2010.210567

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    Footnotes

    • Funding This work was supported in part by a grant-in-aid from the Ministry of Education, Culture, Sports, Science and Technology and by the Program for Promoting the Establishment of Strategic Research Centers, Special Coordination Funds for Promoting Science and Technology, Ministry of Education, Culture, Sports, Science and Technology (Japan).

    • Competing interests None.

    • Ethics approval This study was conducted with the approval of the ethics committee of Tokyo Women's Medical University.

    • Provenance and peer review Not commissioned; externally peer reviewed.