Long-Term Surveillance for Pancreatic Carcinoma Among Patients With Branch-Duct Intraductal Papillary Mucinous Neoplasms.

BACKGROUND

Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are characterized by a relatively slow progression to malignant transformation. We aimed to evaluate the natural history of BD-IPMNs over 10 years, focusing on clinical changes associated with malignancy and identifying predisposing factors.

METHODS

This retrospective cohort study included 308 patients with BD-IPMN monitored for up to 10 years to evaluate the development of pancreatic carcinoma.

RESULTS

The cohort comprised 308 patients with a median follow-up of 67.2 months (range: 6-234). Of these, 197 had long-term follow-up data (≥ 5 years). At 5 years, the cumulative incidence of pancreatic carcinoma was 2.1%, including 0.7% for IPMN-derived invasive carcinoma and 1.4% for de novo pancreatic ductal adenocarcinoma (PDAC). At 10 years, the cumulative incidence increased to 5.5%, with 2.7% for IPMN-derived carcinoma and 2.9% for de novo PDAC. In multivariate analysis, cyst wall thickening (odds ratio [OR]: 23.471; 95% confidence interval [CI]: 5.617-98.072; p < 0.001) and rapid cyst growth (OR: 9.761; 95% CI: 1.145-82.431; p = 0.037) were independently associated with carcinoma. In separate analyses, cyst wall thickening was the only factor independently associated with both IPMN-derived invasive carcinoma (OR: 41.765; 95% CI: 3.992-436.943; p = 0.002) and de novo PDAC (OR: 10.000; 95% CI: 1.570-63.708; p = 0.015).

CONCLUSIONS

The cumulative incidence of both IPMN-derived invasive carcinoma and de novo PDAC reached 5.5% at 10 years. Cyst wall thickening was identified as an independent risk factor. Larger studies are warranted to refine risk stratification and optimize surveillance strategies.