title: Prediction of invasive carcinoma in branch type intraductal papillary mucinous neoplasms of the pancreas.
abstract: BACKGROUND
  Patients with branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) without invasion usually show favorable prognosis. However, the prognosis becomes poor when the IPMN lesions give rise to invasive carcinoma cells. In addition, recent studies have revealed that BD-IPMN is frequently complicated by common type pancreatic ductal carcinoma. Thus, the prognosis of BD-IPMN depends on the occurrence of these two types of invasive carcinoma. However, little is known about the risk factors for the development of these invasive carcinomas in BD-IPMN. This study aims to identify the factors which predict the development of invasive carcinoma in BD-IPMN.
  
  
  METHODS
  Invasive pancreatic carcinoma associating with BD-IPMN was classified as invasive IPMN group (invasive carcinoma derived directly from IPMN lesions) and concomitant group (common type of invasive carcinoma concomitant with BD-IPMN). The relation between the incidence of each type of invasive carcinoma in BD-IPMN and the clinicopathological parameters was retrospectively analyzed.
  
  
  RESULTS
  There were 12 patients with invasive IPMN and 7 patients with concomitant cancer in 159 patients with BD-IPMN. Diameter of dilated branch (P < 0.001) or main pancreatic duct (MPD) (P = 0.001), size of mural nodule (P < 0.001), serum CEA level (P < 0.001) and serum CA19-9 level (P < 0.001) were factors associated significantly with invasive IPMN by univariate analysis. Among these factors, mural nodule with size larger than 6.5 mm [odds ratio 14.86 (95% CI 1.37-60.45); P = 0.02] and serum carcinoembryonic antigen (CEA) level over 5 ng/ml [odds ratio 6.91 (95% CI 1.17-54.13); P = 0.03] were found to be the factors independently associated with invasive IPMN. On the other hand, both univariate and multivariate analyses revealed that elevated carbohydrate antigen 19-9 (CA 19-9) levels were associated with the occurrence of concomitant ductal carcinoma in BD-IPMN [odds ratio 10.31 (95% CI 1.77-81.51); P = 0.01].
  
  
  CONCLUSIONS
  Our results suggested that careful imaging study of the entire pancreas in addition to tumor lesions and measurement of serum CEA and CA19-9 would be required to find out the development of the two types of invasive carcinoma in BD-IPMN.
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aobaku, Sendai, Miyagi 980-8574, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kanno
authors.forename: Kennichi
authors.initials: K
authors.lastname: Satoh
authors.forename: Morihisa
authors.initials: M
authors.lastname: Hirota
authors.forename: Shin
authors.initials: S
authors.lastname: Hamada
authors.forename: Jun
authors.initials: J
authors.lastname: Umino
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Itoh
authors.forename: Atsushi
authors.initials: A
authors.lastname: Masamune
authors.forename: Tohru
authors.initials: T
authors.lastname: Asakura
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000473:pathology*; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen
references.citation: Am J Surg Pathol. 1995 May;19(5):576-89
references.pmid: 7726368
references.citation: Clin Gastroenterol Hepatol. 2008 Jul;6(7):815-9; quiz 719
references.pmid: 18602036
references.citation: Pancreatology. 2002;2(5):484-90
references.pmid: 12378117
references.citation: Gut. 2008 Mar;57(3):339-43
references.pmid: 17660227
references.citation: Br J Surg. 2003 Oct;90(10):1244-9
references.pmid: 14515294
references.citation: Am J Surg. 1996 Apr;171(4):427-31
references.pmid: 8604836
references.citation: Virchows Arch. 1994;425(4):357-67
references.pmid: 7820300
references.citation: Arch Surg. 1999 Oct;134(10):1131-6
references.pmid: 10522860
references.citation: Am J Gastroenterol. 2002 Oct;97(10):2553-8
references.pmid: 12385438
references.citation: Ann Surg. 2004 Jun;239(6):788-97; discussion 797-9
references.pmid: 15166958
references.citation: Ann Surg. 2007 Oct;246(4):644-51; discussion 651-4
references.pmid: 17893501
references.citation: Cancer. 1991 Jul 1;68(1):159-68
references.pmid: 2049738
references.citation: Ann Surg. 1997 Oct;226(4):491-8; discussion 498-500
references.pmid: 9351717
references.citation: Surgery. 2002 Jul;132(1):80-5
references.pmid: 12110799
references.citation: J Gastrointest Surg. 2003 Jan;7(1):12-19
references.pmid: 12559180
references.citation: Am J Gastroenterol. 2007 Aug;102(8):1759-64
references.pmid: 17686073
references.citation: Gastroenterology. 2002 Nov;123(5):1500-7
references.pmid: 12404225
references.citation: Clin Gastroenterol Hepatol. 2006 Oct;4(10):1265-70
references.pmid: 16979953
references.citation: Radiology. 2008 Sep;248(3):876-86
references.pmid: 18632526
references.citation: Pancreas. 2004 Apr;28(3):241-6
references.pmid: 15084964
references.citation: Ann Surg. 2001 Sep;234(3):313-21; discussion 321-2
references.pmid: 11524584
references.citation: Hepatogastroenterology. 2004 Sep-Oct;51(59):1480-3
references.pmid: 15362782
references.citation: Gut. 2008 Nov;57(11):1561-5
references.pmid: 18477671
references.citation: Hepatogastroenterology. 1996 May-Jun;43(9):692-709
references.pmid: 8799417
references.citation: Gut. 2002 Nov;51(5):717-22
references.pmid: 12377813
references.citation: Hepatogastroenterology. 1998 Nov-Dec;45(24):1973-80
references.pmid: 9951850
references.citation: Cancer. 1992 Feb 1;69(3):651-6
references.pmid: 1309676
references.citation: Am J Surg Pathol. 2000 Oct;24(10):1372-7
references.pmid: 11023098
references.citation: J Clin Gastroenterol. 2003 Mar;36(3):261-5
references.pmid: 12590239
references.citation: Ann Surg. 2004 May;239(5):678-85; discussion 685-7
references.pmid: 15082972
references.citation: Pancreatology. 2006;6(1-2):17-32
references.pmid: 16327281
references.citation: Korean J Radiol. 2003 Jul-Sep;4(3):157-62
references.pmid: 14530644
references.citation: Gastrointest Endosc. 1998 Jan;47(1):42-9
references.pmid: 9468422
references.citation: Hepatogastroenterology. 2000 Jul-Aug;47(34):1129-34
references.pmid: 11020896