Intraductal Papillary Mucinous Neoplasm Surveillance Leads to Early Diagnosis and Better Outcomes of Concomitant Cancer.

Abstract

To examine whether long-term surveillance of intraductal papillary mucinous neoplasms (IPMNs) leads to early diagnosis and better clinical outcomes of pancreatic ductal adenocarcinomas (PDACs) developing concomitantly with IPMNs. Long-term image-based surveillance is recommended for patients with low-risk IPMNs. However, it is unknown whether the surveillance can improve surgical and survival outcomes of patients with concomitant PDACs. Using a prospective single-institutional cohort of 4620 patients with pancreatic cysts, including 3638 IPMN patients, we identified 63 patients who developed concomitant PDAC during long-term surveillance. We compared the overall survival of 46 cases with concomitant PDAC to that of 460 matched cases diagnosed with non-IPMN-associated PDAC at the same institution. Multivariable hazard ratios and 95% CIs for overall mortality were computed using the Cox regression model with adjustment for potential confounders. Concomitant PDACs were identified at an earlier cancer stage compared to non-IPMN-associated PDACs, with 67% and 38% cases identified at stage 2 or earlier, respectively ( P <0.001) and 57% and 21% cases with R0 resection, respectively ( P <0.001). Compared with non-IPMN-associated PDACs, concomitant PDACs were associated with longer overall survival ( P =0.034) with a multivariable hazard ratio of 0.61 (95% CI: 0.39-0.96). The 5-year survival rate of patients with concomitant PDAC was higher compared with patients with non-IPMN-associated PDAC (34% vs 18%, respectively; P =0.018). The surveillance for patients with IPMNs was associated with early identification of concomitant PDACs and longer survival of patients diagnosed with this malignancy.