Disease-specific mortality among patients with intraductal papillary mucinous neoplasm of the pancreas.

BACKGROUND & AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is associated with synchronous and metachronous pancreatic cancer. However, the risk factors for pancreatic cancer-specific mortality have not been determined. We evaluated disease-specific mortality among patients with IPMNs harboring high-risk stigmata.

METHODS

We analyzed data from 243 patients diagnosed with IPMN, with indications for surgery according to the consensus criteria, at the University of Tokyo Hospital from 1995 to January 2011. By using optimal matching and propensity scores based on 16 characteristics, we matched patients who underwent surgery at diagnosis with those who did not undergo surgery. A competing risk analysis was used to assess the risk of pancreatic cancer-specific mortality.

RESULTS

Fifty-nine patients underwent surgery after diagnosis and 184 did not. After adjustment with propensity scores, detection of a hypo-attenuating area by computed tomography, which indicates invasive carcinoma, was associated significantly with pancreatic cancer-specific mortality (adjusted hazard ratio, 16.75; 95% confidence interval, 2.72-103.3; P = .002). Cyst diameter, main pancreatic duct diameter, and the presence of a mural nodule were not associated significantly with pancreatic cancer-specific mortality. Surgical management was found to reduce pancreatic cancer-specific mortality, especially in patients with hypo-attenuating areas (P = .038).

CONCLUSIONS

Detection of a hypo-attenuating area by computed tomography significantly increases the risk for pancreatic cancer-specific mortality among IPMN patients with consensus indications for surgery. Surgical resection significantly reduces this risk.