Obesity increases malignant risk in patients with branch-duct intraductal papillary mucinous neoplasm.
BACKGROUND
Obesity is an established risk factor for pancreatic adenocarcinoma. No study has examined specifically the influence of obesity on malignant risk in patients with intraductal papillary mucinous neoplasm (IPMN), a group at substantial risk of pancreatic adenocarcinoma. We hypothesize that obesity is associated with a greater frequency of malignancy in IPMN.


METHODS
Data on patients undergoing resection for IPMN between 1992 and 2012 at a high-volume university institution were collected prospectively. Clinicopathologic and demographic parameters were reviewed. Patients were classified according to World Health Organization categories of body mass index (BMI). Malignancy was defined as high-grade dysplastic or invasive IPMN.


RESULTS
We collected data on 357 patients who underwent resection for IPMN. Of these, 274 had complete data for calculation of preoperative BMI and 31% had malignant IPMN. Of 254 patients with a BMI of <35 kg/m(2), 30% had malignant IPMN versus 50% in patients with BMI of ≥35 (P = .08). In branch-duct IPMN, patients with a BMI of <35 had 12% of malignant IPMN compared with 46% in severely obese patients (P = .01). Alternatively, in main-duct IPMN, no difference was found in the malignancy rate (48% vs 56%; P = .74).


CONCLUSIONS
These findings suggest that obesity is associated with an increased frequency of malignancy in branch-duct IPMN. Obesity is a potentially modifiable risk factor that may influence oncologic risk stratification, patient counseling, and surveillance strategy.
Department of Surgery, Division of Gastroenterology and Hepatology, Indiana University Hospital, Indianapolis, IN.
Emily C
EC
Sturm
Alexandra M
AM
Roch
Kristina M
KM
Shaffer
Christian M
CM
Schmidt
Se-Joon
SJ
Lee
Nicholas J
NJ
Zyromski
Henry A
HA
Pitt
John M
JM
Dewitt
Mohammad A
MA
Al-Haddad
Joshua A
JA
Waters
C Max
CM
Schmidt
D002288:Adenocarcinoma, Mucinous / Q000209:etiology* / Q000601:surgery; D000368:Aged; D015992:Body Mass Index; D021441:Carcinoma, Pancreatic Ductal / Q000209:etiology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D009765:Obesity / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000209:etiology* / Q000601:surgery; D011446:Prospective Studies; D012306:Risk; D012907:Smoking / Q000009:adverse effects