The Natural History of Main Duct–Involved, Mixed-Type Intraductal Papillary Mucinous Neoplasm

摘要: Objective: As such, the natural history of MPD-involved IPMN is poorly understood. Background: The high-risk malignancy associated with main pancreatic duct (MPD)-involved intraductal papillary mucinous neoplasm (IPMN) has been established by surgical series. International Consensus Guidelines recommend resection in fit patients. Methods: A review a prospectively collected database (1992–2012) patients undergoing primary surveillance was performed. Invasive progression defined as invasive carcinoma on pathology and/or positive cytopathology. Analyses included univariate, logistic regression, and receiver operating characteristic curve analyses. Results: total 503 underwent surveillance, 70 for MPD-involved, mixed-type IPMN. Indications intensive these were comorbidities, patient choice, early/borderline MPD dilation (42%, 51%, 7%, respectively). Mean follow-up 4.7 years. Nine (13%) progressed at mean 3.5 (range, 1–9) years during follow-up. Univariate analyses yielded weight loss, interval (from isolated branch-duct IPMN) to involvement, diffuse dilation, increase diameter, absence extra cysts, elevated serum CA19-9 levels, alkaline phosphatase levels significant. Maximum diameter not In cysts predictors invasiveness. indicated that combination 4 factors achieved an accuracy 98% predicting progression. Conclusions: Primary may be reasonable strategy select Diffuse CA19-9, phosphatase, extrapancreatic predict likely progress surveillance.