Malignant transformation and overall survival of morphological subtypes of intraductal papillary mucinous neoplasms of the pancreas: A network meta-analysis.
BACKGROUND
Emerging evidence suggests the predictive role of morphological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) of intraductal papillary mucinous neoplasms (IPMNs) in malignant transformation and overall survival. But results of these studies are currently discordant.


METHODS
A comprehensive literature search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) was conducted for eligible studies. Network meta-analysis using the random-effect model was carried out to detect differences in incidences of invasive IPMNs and hazard ratios from survival curves among four morphological subtypes.


RESULTS
19 studies were included in the network comparison. The outcomes showed that pancreatobiliary-type (OR for odds ratio=25.87, 95% CI: 12.11-52.10, compared with gastric-type) and oncocytic-type (OR=18.59, 95% CI: 7.18-42.74) IPMNs had the highest risks of progressing to invasive IPMNs, followed by intestinal-type (OR=5.71, 95% CI: 2.85-10.61) and gastric-type IPMNs. With the gastric type as the baseline, pancreatobiliary-type IPMNs were found to have the worst prognosis (HR for hazard ratio=5.05, 95% CrI: 1.33-13.47) while no significant differences were found for the intestinal type (HR=1.90, 95% CrI: 0.59-4.58) and the oncocytic type (HR=3.29, 95% CrI: 0.75-9.71).


CONCLUSIONS
It is suggested that pancreatobiliary-type IPMNs are the most likely to become invasive and are associated with poor prognosis. In contrast, the other three subtypes have similar overall survivals even though the oncocytic- and intestinal-type IPMNs are predisposed to be more invasive than gastric-type IPMNs.
Department of General Surgery, 302 Hospital of PLA, Beijing 100039, China; Division of Surgical Oncology, Brigham and Women's Hospital, Boston, MA, USA.
Xiaolong
X
Qi
Department of General Surgery, 302 Hospital of PLA, Beijing 100039, China.
Xin
X
Zhao
Department of Endocrinology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
Junlei
J
Su
Department of Endocrinology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
Mingxin
M
Xu
Department of Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029 China.
Weifeng
W
Zhang
Department of Endocrinology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
Hui
H
Sheng
Department of General Surgery, 302 Hospital of PLA, Beijing 100039, China. Electronic address: lzw302@163.com.
Zhiwei
Z
Li
Division of Surgical Oncology, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: jipingwangbwh@126.com.
Jiping
J
Wang
D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000145:classification / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D016019:Survival Analysis
Intraductal papillary mucinous neoplasms of the pancreas; Malignant transformation; Morphological subtype; Overall survival