title: Risk factors for malignant progression of intraductal papillary mucinous neoplasms.
abstract: BACKGROUND
  Intraductal papillary mucinous neoplasms of the pancreas are increasingly diagnosed. Due to their malignant potential, greater understanding of their nature is required.
  
  
  OBJECTIVE
  Define risk factors for malignancy in intraductal papillary mucinous neoplasms.
  
  
  METHODS
  An international, multicentre study was performed in Europe and the United States. Clinical databases were reviewed for patients with intraductal papillary mucinous neoplasms diagnosis.
  
  
  RESULTS
  Of 1126 patients, 84 were diagnosed with invasive carcinoma/high-grade dysplasia and were compared to the rest of the cohort. Multivariate logistic analysis showed a statistically significant association between cancer/high-grade dysplasia and the variables smoking history (OR 1.9, 95% CI [1.1-3.1]), body mass index (OR 1.1, 95% CI [1-1.1]), symptoms (OR 3.4, 95% CI [1.9-6]), jaundice (OR 0.1, 95% CI [0-0.3]), and steatorrhea (OR 0.3, 95% CI [0.1-0.8]). Univariate analysis showed no association between malignancy and the cyst number/location (p=0.3 and p=0.5, respectively) although a strong association was shown for cyst size (p<0.001). The presence and size of nodules (p<0.01) and main duct involvement (p<0.001) were also strongly related with malignancy.
  
  
  CONCLUSIONS
  The presence of jaundice and steatorrhea, smoking, high body mass index, and imaging features such as cyst size, main duct involvement, and the presence and size of mural nodules are associated with high-grade neoplasia in intraductal papillary mucinous neoplasms.
authors: Mayo Clinic, Jacksonville, FL, USA; Programa de Doctorat en Medicina de la Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Maria
authors: M
authors: Moris
authors: Mayo Clinic, Jacksonville, FL, USA.
authors: Massimo
authors: M
authors: Raimondo
authors: Mayo Clinic, Jacksonville, FL, USA.
authors: Timothy A
authors: TA
authors: Woodward
authors: Mayo Clinic, Jacksonville, FL, USA.
authors: Verna
authors: V
authors: Skinner
authors: San Raffaele Scientific Institute, Milano, Italy.
authors: Paolo G
authors: PG
authors: Arcidiacono
authors: San Raffaele Scientific Institute, Milano, Italy.
authors: Maria C
authors: MC
authors: Petrone
authors: Azienda Universitario-Ospedaliera San Giovanni Battista, Torino, Italy.
authors: Claudio
authors: C
authors: De Angelis
authors: Azienda Universitario-Ospedaliera San Giovanni Battista, Torino, Italy.
authors: Selene
authors: S
authors: Manfrè
authors: University of Bologna/Hospital of Imola, Imola, Italy.
authors: Pietro
authors: P
authors: Fusaroli
authors: Mayo Clinic, Jacksonville, FL, USA. Electronic address: Wallace.michael@mayo.edu.
authors: Michael B
authors: MB
authors: Wallace
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000209:etiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000209:etiology / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000209:etiology / Q000473:pathology*; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D010190:Pancreatic Neoplasms / Q000209:etiology / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Pancreatic adenocarcinoma; Pancreatic cystic neoplasm