Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas (original) (raw)

Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas

Toru Furukawa1,2,
Takashi Hatori3,
Izumi Fujita3,
Masakazu Yamamoto3,
Makio Kobayashi2,4,
Nobuyuki Ohike5,
Toshio Morohoshi5,
Shinichi Egawa6,
Michiaki Unno6,
Sonshin Takao7,
Masahiko Osako8,
Suguru Yonezawa9,
Mari Mino-Kenudson10,
Gregory Y Lauwers10,
Hiroshi Yamaguchi11,
Shinichi Ban11,
Michio Shimizu11
1Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
2Department of Surgical Pathology, Tokyo Women's Medical University Hospital, Tokyo, Japan
3Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
4Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
5First Department of Pathology, Showa University School of Medicine, Tokyo, Japan
6Division of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
7Frontier Science Research Center, Kagoshima University, Kagoshima, Japan
8Department of Surgery, Kagoshima-shi Medical Association Hospital, Kagoshima, Japan
9Department of Human Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
10Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
11Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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

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