title: Development of Pancreatic Cancer, Disease-specific Mortality, and All-Cause Mortality in Patients with Nonresected IPMNs: A Long-term Cohort Study.
abstract: OBJECTIVE
  To determine the cumulative incidence, disease-specific mortality, and all-cause mortality of pancreatic cancer (PC) in patients with intraductal papillary mucinous neoplasms (IPMNs) and to identify imaging findings that are associated with these outcomes.
  
  
  METHODS
  This retrospective study had institutional review board approval, and the need to obtain patient consent was waived. Data from an electronic database were analyzed and supplemented by chart reviews for 285 patients with nonresected IPMNs who were periodically followed up with imaging (1273 multidetector computed tomography and 750 magnetic resonance cholangiopancreatography examinations). The Kaplan-Meier method was used to estimate the cumulative development of PC, PC mortality, and all-cause mortality (factors were compared by using the log-rank test).
  
  
  RESULTS
  Over a median imaging follow-up period of 39 months, 12 (4.2%) of 285 patients developed PC; the cumulative 5-year PC incidence was 3.9% for branch duct (BD)-IPMNs, 45.5% for main duct (MD)-IPMNs (P < .01), 7.7% for cysts 30 mm or larger, and 5.3% for cysts smaller than 30 mm (P = .82). Over a median survival follow-up period of 47.5 months, seven (2.5%) of 285 patients died of PC and 14 (4.9%) patients died of other causes. Cumulative 5-year PC mortality was 2.1% for BD-IPMNs, 18.5% for MD-IPMNs (P < .01), 2.6% for cysts 30 mm or larger, and 2.8% for cysts smaller than 30 mm (P = .90). Cumulative 5-year all-cause mortality was 5.5% for BD-IPMNs, 18.5% for MD-IPMNs (P < .01), 12.5% for cysts 30 mm or larger, and 5.9% for cysts smaller than 30 mm (P = .89).
  
  
  CONCLUSIONS
  Five-year PC development, disease-specific mortality, and all-cause mortality were approximately 4%, 2%, and 6% for BD-IPMNs and 46%, 19%, and 19% for MD-IPMNs, respectively. The presence of an MD-IPMN, but not cyst size, was significantly associated with PC development and subsequent mortality.
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Akihito
authors.initials: A
authors.lastname: Kawazoe
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Saori
authors.initials: S
authors.lastname: Mishima
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Wada
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Katsunori
authors.initials: K
authors.lastname: Sekine
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Koh
authors.initials: K
authors.lastname: Imbe
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kojima
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Keigo
authors.initials: K
authors.lastname: Kumazawa
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Fuminori
authors.initials: F
authors.lastname: Mihara
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Makoto
authors.initials: M
authors.lastname: Tokuhara
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Edamoto
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Toru
authors.initials: T
authors.lastname: Igari
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Mikio
authors.initials: M
authors.lastname: Yanase
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.affiliation: From the Department of Gastroenterology and Hepatology (N.N., A.K., S.M., K.S., K.W., K.I., Y.K., M.Y., J.A.), Department of Diagnostic Radiology (T.W.), Department of Clinical Research and Informatics, International Clinical Research Center Research Institute (T.S.), Department of Surgery (K.K., F.M., M.T., Y.E.), and Department of Clinical Pathology (T.I.), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan; and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan (M.M., N.U.).
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000401:mortality; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000401:mortality; D002423:Cause of Death; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media