title: Trends in malignant intraductal papillary mucinous neoplasm in US adults from 1990 to 2010: a SEER database analysis.
abstract: BACKGROUND
  Intraductal papillary mucinous neoplasms (IPMNs) are precancerous lesions with a well-described adenoma-carcinoma sequence. Although the risk of malignant transformation has been well studied, data on trends in long-term survival and important prognostic factors associated with survival in malignant IPMN are lacking.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with confirmed malignant IPMN based upon pathologic diagnosis or radiographic evidence concerning for malignant potential. Median survival and age-adjusted incidence were calculated. Cox proportional hazard regression was used to determine independent mortality factors.
  
  
  RESULTS
  Based upon the SEER database query, 2651 patients were diagnosed with malignant IPMN between 1990 and 2010. The age-adjusted incidence of IPMN in 1990 was 0.361 per 100 000 persons (95% confidence interval [CI]: 0.285-0.451) with a steady decline observed through 2010 (0.135 per 100 000 persons, 95% CI: 0.098-0.186). A total of 564 patients (21.3%) underwent a surgical procedure, though the number of patients who underwent surgery from 1990 to 2010 also decreased (1990-1995, n = 132 to 2006-2010, n = 96, respectively). The overall median survival was 4 months and remained relatively stable from 1990 to 2010. Performance of surgery (HR: 0.45, 95% CI: 0.40-0.53, P < 0.001) was associated with a decreased risk of death.
  
  
  CONCLUSIONS
  A significant decrease in the incidence of malignant IPMN was seen from 1990 to 2010. There was also no improvement observed in long-term survival. The small percentage of eligible cases receiving surgical treatment suggests that there is room for further improvement in survival, with increased utilization of surgery.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: McCarty
authors.affiliation: Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA and Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, CT, USA basile.njei@yale.edu.
authors.forename: Basile
authors.initials: B
authors.lastname: Njei
keywords: incidence; intraductal papillary mucinous neoplasm (IPMN); long-term survival; malignant transformation
references.citation: Curr Opin Gastroenterol. 2015 Sep;31(5):424-9
references.pmid: 26125316
references.citation: Int J Gastrointest Cancer. 2001;30(1-2):47-63
references.pmid: 12489580
references.citation: Hematol Oncol Clin North Am. 2015 Aug;29(4):655-74
references.pmid: 26226903
references.citation: Ann Surg Oncol. 2008 Feb;15(2):415-23
references.pmid: 17987343
references.citation: Am J Epidemiol. 1989 Nov;130(5):1024-32
references.pmid: 2683747
references.citation: Ann Surg. 2004 Jun;239(6):788-97; discussion 797-9
references.pmid: 15166958
references.citation: World J Gastrointest Surg. 2010 Oct 27;2(10):337-41
references.pmid: 21160840
references.citation: Surgery. 1997 Sep;122(3):617-25
references.pmid: 9308621
references.citation: J Gastrointest Surg. 2006 Nov;10(9):1199-210; discussion 1210-1
references.pmid: 17114007
references.citation: Pancreatology. 2006;6(1-2):17-32
references.pmid: 16327281
references.citation: Gastroenterology. 1991 Aug;101(2):512-9
references.pmid: 1648527
references.citation: Hepatology. 2001 Jan;33(1):62-5
references.pmid: 11124821
references.citation: AJR Am J Roentgenol. 2008 Sep;191(3):802-7
references.pmid: 18716113
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-3-18
references.pmid: 12187163
references.citation: J Surg Res. 2011 May 15;167(2):251-7
references.pmid: 19765732
references.citation: Gastroenterology. 1996 Jun;110(6):1909-18
references.pmid: 8964418
references.citation: Clin Gastroenterol Hepatol. 2012 May;10(5):555-8
references.pmid: 22210438
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-43-8
references.pmid: 12187167
references.citation: Ann Surg. 1998 Nov;228(5):685-91
references.pmid: 9833807
references.citation: Ann Surg. 2004 May;239(5):678-85; discussion 685-7
references.pmid: 15082972
references.citation: Pancreatology. 2012 May-Jun;12(3):183-97
references.pmid: 22687371
references.citation: Gastroenterology. 2013 Jun;144(6):1303-15
references.pmid: 23622140
references.citation: Cancer. 1989 Sep 15;64(6):1329-35
references.pmid: 2548703
references.citation: Cancer. 1992 Feb 1;69(3):651-6
references.pmid: 1309676
references.citation: Int J Pancreatol. 1995 Dec;18(3):197-206
references.pmid: 8708390