Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery?
BACKGROUND
Despite recently increasing numbers of reports on intraductal papillary mucinous tumors (IPMTs), difficulties still remain in terms of diagnosis, treatment, and prognosis. The purpose of this multicenter study was to evaluate the clinicopathologic features of IPMT in Korea and to suggest predictive criteria for malignancy in IPMT.


METHODS
We retrospectively reviewed the clinicopathologic data of 208 patients who underwent operations for IPMT between 1993 and 2002 at 28 institutes in Korea.


RESULTS
Of the 208 patients (mean age, 61 years), 147 were men and 61 were women. A total of 124 patients underwent pancreatoduodenectomy, 42 underwent distal pancreatectomy, 17 underwent total pancreatectomy, and 25 underwent limited pancreatic resection. There were 128 benign cases (adenoma, n = 62; borderline, n = 66) and 80 malignant cases (noninvasive, n = 29; invasive, n = 51). A significant difference in 5-year survival was observed between the benign and malignant groups (92.6% vs. 65.3%; P = .006). Of the six factors (age, location, duct dilatation, mural nodule, main duct type, and tumor size) that showed statistical differences by univariate analysis between the benign and malignant groups, three were significant by multivariate analysis--namely, mural nodule (P = .009), tumor size (P = .023), and a dilated duct size (P = .010).


CONCLUSIONS
A significant proportion of IPMTs are malignant, although the overall prognosis of IPMT is superior to that of ordinary pancreatic cancer. Radical surgery is recommended for IPMT with the predictors of malignancy: mural nodule, tumor size (> or =30 mm), and dilated duct size (> or =12 mm).
Jang
Jin-Young
JY
Department of Surgery, Seoul National University Hospital, 28 Yongon-dong, Changno-gu, 110-744 Seoul, Korea.
Kim
Sun-Whe
SW
Ahn
Young Joon
YJ
Yoon
Yoo-Seok
YS
Choi
Min Gew
MG
Lee
Kuhn Uk
KU
Han
Joon Koo
JK
Kim
Woo Ho
WH
Lee
Young Joo
YJ
Kim
Song Chul
SC
Han
Duck Jong
DJ
Kim
Yong Il
YI
Choi
Seong Ho
SH
Cho
Baik Hwan
BH
Yu
Hee Chul
HC
Yoon
Dong Sup
DS
Lee
Woo Jung
WJ
Lee
Kyung Bum
KB
Kim
Young Chul
YC
Lee
Kwang Soo
KS
Kim
Myung-Wook
MW
Kim
Hong Jin
HJ
Kim
Hyun Jong
HJ
Park
Yong-Hyun
YH
D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology*; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis