# Clinical Features of Intraductal Papillary Mucinous Neoplasm-Related Pancreatic Carcinomas in Long-Term Surveillance

## TL;DR

The study identifies clinical features that increase the risk of cancer development in patients with intraductal papillary mucinous neoplasms, guiding long-term surveillance strategies.

## Contribution

The study introduces a risk stratification model for IPMN-related carcinomas based on specific clinical features and their impact on malignant transformation.

## Key findings

- IPMN-derived carcinoma and concomitant pancreatic ductal adenocarcinoma were identified in 7.5% and 2.5% of patients, respectively.
- Maximum cyst diameter ≥ 30 mm, septal nodal structure, and abnormal CA19-9 levels were significant risk factors for cancer development.
- Patients with these risk factors had a higher likelihood of developing IPMN-DC or c-PDAC over time.

## Abstract

Background and Aims: An appropriate surveillance system must be established to efficiently identify cases of intraductal papillary mucinous neoplasm (IPMN)-related malignant transformation. We analyzed the initial clinical background that affects long-term prognosis and narrowed the population for whom continued evaluation is inevitable. Methods: We included 1645 patients with IPMN treated at our hospital since 2010. We examined the types and timing of malignant transformation in terms of the worrisome features (WFs). The chi-squared test, log-rank test, and Cox proportional hazards model were used for the analysis (statistical significance at α = 0.05). Results: In total, 123 (7.5%) and 41 patients (2.5%) had IPMN-derived carcinoma (IPMN-DC) and concomitant pancreatic ductal adenocarcinoma (c-PDAC), respectively. Compared with IPMN-DC, a significantly higher proportion of c-PDAC patients were diagnosed with an advanced disease stage that developed earlier. The factors with significantly shorter time for IPMN-DC development were maximum cyst diameter (MCD) ≥ 30 mm, nonbranched type, main pancreatic duct (MPD) diameter ≥ 5 mm, and septal nodal structure (SNS) for IPMN-DC, and MCD ≥ 30 mm, main duct type, MPD ≥ 5 mm, SNS, cyst enlargement (≥2.5 mm/year), and abnormal CA19-9 levels for c-PDAC. Both groups could be significantly stratified by the number of WFs. A relative risk analysis revealed that SNS, MCD ≥ 30 mm, and MPD ≥ 5 mm were significant factors for IPMN-DC, whereas abnormal CA19-9 and SNS were significant for c-PDAC. Conversely, significantly more patients exhibiting these factors initially later developed IPMN-DC or c-PDAC. Conclusions: Ten percent of IPMN cases will develop IPMN-DC or c-PDAC, thereby requiring careful follow-up, especially in cases with SNS, abnormal CA19-9, and MCD ≥ 30 mm.