Ji Hye Min1, Young Kon Kim2, Honsoul Kim1, Dong Lk Cha1, Soohyun Ahn3. 1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea. 2. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea. youngkon0707.kim@samsung.com. 3. Department of Mathematics, Ajou University, Suwon, Republic of Korea.
Abstract
PURPOSE: Although there has been considerable effort to define pre-operative features to predict the malignant potential of intraductal papillary mucinous neoplasms (IPMNs), the prognostic value of pre-operative clinical and MRI features has not been assessed. The aim of this study was to determine pre-operative clinical and MRI features that are predictive of disease-specific death or recurrence in patients undergoing pancreatic resection for IPMNs. METHODS: We performed a retrospective analysis of 167 patients (mean age, 65 years; 114 men and 53 women) who underwent pre-operative MRI and surgical resection of IPMN of pancreas between 2009 and 2019. We evaluated disease-specific survival (DSS) and recurrence-free survival (RFS). Prognostic factor analysis was performed using clinical and MRI features according to the 2017 international consensus guidelines. RESULTS: Of 167 patients, 86 (51.5%) had benign IPMNs and 81 (48.5%) had malignant IPMNs (48 [28.7%] invasive carcinoma and 33 [19.8%] high grade). On multivariable analysis, mural nodule size (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.04-1.18 and HR 1.07; 95% CI 1.03-1.12) and obstructive jaundice (HR 5.01; 95% CI 1.44-17.46 and HR 5.60; 95% CI 2.42-12.99) were the significant variables that were associated with DSS and RFS. The presence of lymphadenopathy (HR 50.7; 95% CI 4.0-643.0; P = 0.002) was the significant factor for DSS. IPMNs with mural nodule showed a significantly lower 5-year DSS (83.7% vs. 100%, P value < 0.01) and RFS (73.1% vs. 95.0%, P value < 0.01) compared with IPMNs with no mural nodule. CONCLUSIONS: Mural nodule size on MRI and obstructive jaundice were prognostic markers in the pre-operative evaluation of patients with IPMN of pancreas.
PURPOSE: Although there has been considerable effort to define pre-operative features to predict the malignant potential of intraductal papillary mucinous neoplasms (IPMNs), the prognostic value of pre-operative clinical and MRI features has not been assessed. The aim of this study was to determine pre-operative clinical and MRI features that are predictive of disease-specific death or recurrence in patients undergoing pancreatic resection for IPMNs. METHODS: We performed a retrospective analysis of 167 patients (mean age, 65 years; 114 men and 53 women) who underwent pre-operative MRI and surgical resection of IPMN of pancreas between 2009 and 2019. We evaluated disease-specific survival (DSS) and recurrence-free survival (RFS). Prognostic factor analysis was performed using clinical and MRI features according to the 2017 international consensus guidelines. RESULTS: Of 167 patients, 86 (51.5%) had benign IPMNs and 81 (48.5%) had malignant IPMNs (48 [28.7%] invasive carcinoma and 33 [19.8%] high grade). On multivariable analysis, mural nodule size (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.04-1.18 and HR 1.07; 95% CI 1.03-1.12) and obstructive jaundice (HR 5.01; 95% CI 1.44-17.46 and HR 5.60; 95% CI 2.42-12.99) were the significant variables that were associated with DSS and RFS. The presence of lymphadenopathy (HR 50.7; 95% CI 4.0-643.0; P = 0.002) was the significant factor for DSS. IPMNs with mural nodule showed a significantly lower 5-year DSS (83.7% vs. 100%, P value < 0.01) and RFS (73.1% vs. 95.0%, P value < 0.01) compared with IPMNs with no mural nodule. CONCLUSIONS: Mural nodule size on MRI and obstructive jaundice were prognostic markers in the pre-operative evaluation of patients with IPMN of pancreas.
Entities:
Keywords:
Guideline; Magnetic resonance imaging; Pancreatic intraductal neoplasms; Prognosis
Authors: Olca Basturk; Seung-Mo Hong; Laura D Wood; N Volkan Adsay; Jorge Albores-Saavedra; Andrew V Biankin; Lodewijk A A Brosens; Noriyoshi Fukushima; Michael Goggins; Ralph H Hruban; Yo Kato; David S Klimstra; Günter Klöppel; Alyssa Krasinskas; Daniel S Longnecker; Hanno Matthaei; G Johan A Offerhaus; Michio Shimizu; Kyoichi Takaori; Benoit Terris; Shinichi Yachida; Irene Esposito; Toru Furukawa Journal: Am J Surg Pathol Date: 2015-12 Impact factor: 6.394
Authors: George A Poultsides; Sushanth Reddy; John L Cameron; Ralph H Hruban; Timothy M Pawlik; Nita Ahuja; Ajay Jain; Barish H Edil; Christine A Iacobuzio-Donahue; Richard D Schulick; Christopher L Wolfgang Journal: Ann Surg Date: 2010-03 Impact factor: 12.969
Authors: Masao Tanaka; Carlos Fernández-Del Castillo; Terumi Kamisawa; Jin Young Jang; Philippe Levy; Takao Ohtsuka; Roberto Salvia; Yasuhiro Shimizu; Minoru Tada; Christopher L Wolfgang Journal: Pancreatology Date: 2017-07-13 Impact factor: 3.996
Authors: Mari Mino-Kenudson; Carlos Fernández-del Castillo; Yoshifumi Baba; Nakul P Valsangkar; Andrew S Liss; Maylee Hsu; Camilo Correa-Gallego; Thun Ingkakul; Rocio Perez Johnston; Brian G Turner; Vasiliki Androutsopoulos; Vikram Deshpande; Deborah McGrath; Dushyant V Sahani; William R Brugge; Shuji Ogino; Martha B Pitman; Andrew L Warshaw; Sarah P Thayer Journal: Gut Date: 2011-04-20 Impact factor: 23.059
Authors: Ye Xin Koh; Hui Li Zheng; Aik-Yong Chok; Chuen Seng Tan; Wyiki Wyone; Tony K H Lim; Damien M Y Tan; Brian K P Goh Journal: Surgery Date: 2015-02-03 Impact factor: 3.982