Highlights
- •Pancreatobiliary-type IPMNs are the most likely to become invasive with poorest prognosis.
- •The oncocytic-, intestinal- and gastric-type IPMNs have similar overall survivals.
- •The oncocytic- and intestinal-type IPMNs are more invasive than the gastric type.
Abstract
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).
Conclusion
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intraductal papillary mucinous tumor of the pancreas.Gastrointest Endosc. 2002; 55: 701-714
- An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms.Am J Surg Pathol. 2004; 28: 977-987
- International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas.Pancreatology. 2006; 6: 17-32
- Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas.J Gastroenterol. 2005; 40: 669-675
- Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal.Virchows Arch. 2004; 445: 168-178
- Outcomes following resection of invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas.Am J Surg. 2005; 189: 632-636
- Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas.Gastroenterology. 2002; 123: 1500-1507
- Surgical outcome of intraductal papillary mucinous neoplasms of the pancreas.Ann Surg Oncol. 2007; 14: 3174-3180
- Minimally invasive intraductal papillary-mucinous carcinoma of the pancreas: clinicopathologic study of 104 intraductal papillary-mucinous neoplasms.Am J Surg Pathol. 2008; 32: 243-255
- Outcome of invasive and noninvasive intraductal papillary-mucinous neoplasms of the pancreas (IPMN): a 10-year experience.World J Surg. 2008; 32: 2253-2260
- Intraductal papillary mucinous neoplasms of the pancreas: an updated experience.Ann Surg. 2004; 239: 788-797
- Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection.Gastroenterology. 2007; 133: 72-79
- Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection.Ann Surg. 2004; 239: 678-685
- Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology.Ann Surg. 2007; 246: 644-651
- Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas.Arch Surg. 2008; 143: 639-646
- International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas.Pancreatology. 2012; 12: 183-197
- Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome.Ann Surg. 2004; 239: 400-408
- Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma.Gut. 2002; 51: 717-722
- Invasive cancer and survival of intraductal papillary mucinous tumors of the pancreas.Am J Gastroenterol. 2002; 97: 2553-2558
- Pathohistological subtype predicts survival in patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Ann Surg. 2013; 258: 324-330
- Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas.Gut. 2011; 60: 509-516
- Evaluation of clinical meaning of histological subtypes of intraductal papillary mucinous neoplasm of the pancreas.Pancreas. 2013; 42: 959-966
- Clinical implication of morphological subtypes in management of intraductal papillary mucinous neoplasm.Ann Surg Oncol. 2014; 21: 2444-2452
- The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification.Acta Pathol Microbiol Scand. 1965; 64: 31-49
- Different clinicopathologic findings in two histologic types of carcinoma of papilla of Vater.Jpn J Cancer Res. 1994; 85: 161-166
- Gene expression of gastric type mucin (MUC5AC) in pancreatic tumors: its relationship with the biological behavior of the tumor.Pathol Int. 1999; 49: 45-54
- Pathologically and biologically distinct types of epithelium in intraductal papillary mucinous neoplasms: delineation of an "intestinal" pathway of carcinogenesis in the pancreas.Am J Surg Pathol. 2004; 28: 839-848
- Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study.Virchows Arch. 2005; 447: 794-799
- Pancreatic intraductal papillary-mucinous neoplasms: a new and evolving entity.Virchows Arch. 2007; 451: 863-869
- Intraductal Papillary-Mucinous Neoplasms of the Pancreas.in: Bosman F.T. Carneiro F. Hruban R.H. Theise N.D. World Health Organization Classification of Tumors, Pathology and Genetics of Tumors of the Digestive System. IARC Press, 2010: 304-313
- Intraductal Papillary-Mucinous Neoplasms of the Pancreas.in: Hamilton S.R. Bltonen L.A. World Health Organization Classification of Tumors, Pathology and Genetics of Tumours of the Digestive System. IARC Press, 2000: 237-240
Japan Pancreas Society. Classification of Pancreatic Carcinoma. 2nd English ed. Tokyo JK.
- General Rules for the Study of Pancreatic Cancer.in: 6th ed. Kanehara T, 2009
- Practical methods for incorporating summary time-to-event data into meta-analysis.Trials. 2007; 8: 16
- Network meta-analysis on the log-hazard scale, combining count and hazard ratio statistics accounting for multi-arm trials: a tutorial.BMC Med Res Methodol. 2010; 10: 54
- Potential usefulness of mucin immunohistochemical staining of preoperative pancreatic biopsy or juice cytology specimens in the determination of treatment strategies for intraductal papillary mucinous neoplasm.Oncol Rep. 2013; 30: 2035-2041
- Characteristic clinicopathological features of the types of intraductal papillary-mucinous neoplasms of the pancreas.Pancreas. 2007; 35: 348-352
- Prognostic relevance of pathologic subtypes and minimal invasion in intraductal papillary mucinous neoplasms of the pancreas.Tumour Biol. 2011; 32: 535-542
- Intraductal papillary-mucinous neoplasms of the gastric and intestinal types may have less malignant potential than the pancreatobiliary type.Pancreas. 2010; 39: 604-610
- Histologic, immunohistochemical, and molecular classification of 52 IPMNs of the pancreas.Appl Immunohistochem Mol Morphol. 2009; 17: 31-39
- Preoperative histological subtype classification of intraductal papillary mucinous neoplasms (IPMN) by pancreatic juice cytology with MUC stain.Ann Surg. 2013; 257: 1103-1111
- Pancreatic juice cytology and subclassification of intraductal papillary mucinous neoplasms of the pancreas.Pancreas. 2007; 34: 197-204
- Cripto-1 overexpression is involved in the tumorigenesis of gastric-type and pancreatobiliary-type intraductal papillary mucinous neoplasms of the pancreas.Oncol Rep. 2009; 21: 19-24
- IPMN involving the main pancreatic duct: biology, epidemiology, and long-term outcomes following resection.Ann Surg. 2015; 261: 976-983
- CD44v6 expression in intraductal papillary mucinous neoplasms of the pancreas.Pancreas. Jan 2010; 39: 31-35
- Invasive carcinoma derived from intestinal-type intraductal papillary mucinous neoplasm is associated with minimal invasion, colloid carcinoma, and less invasive behavior, leading to a better prognosis.Pancreas. 2011; 40: 581-587
- Stromal thrombospondin-1 expression is a prognostic indicator and a new marker of invasiveness in intraductal papillary-mucinous neoplasm of the pancreas.Biomed Res. 2010; 31: 13-19
- Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection: a retrospective review.Ann Surg. 2014; 259: 360-368
- Molecular characteristics and biological behaviours of the oncocytic and pancreatobiliary subtypes of intraductal papillary mucinous neoplasms.J Pathol. 2011; 224: 508-516
- Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct.Am J Surg Pathol. 2000; 24: 1372-1377
- New classification of pancreatic intraductal papillary-mucinous tumour by mucin expression: its relationship with potential for malignancy.J Pathol. 2002; 197: 201-210
- Colloid (mucinous noncystic) carcinoma of the pancreas.Am J Surg Pathol. 2001; 25: 26-42
- Invasive intraductal papillary-mucinous neoplasm of the pancreas: comparison with pancreatic ductal adenocarcinoma.J Surg Oncol. 2009; 100: 13-18
Article info
Publication history
Published online: August 11, 2015
Accepted:
July 19,
2015
Received in revised form:
July 15,
2015
Received:
May 27,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
