Association between the Risk Factors for Pancreatic Ductal Adenocarcinoma and Those for Malignant Intraductal Papillary Mucinous Neoplasm

Kamata, Ken; Takenaka, Mamoru; Nakai, Asami; Omoto, Shunsuke; Miyata, Takeshi; Minaga, Kosuke; Matsuda, Tomohiro; Yamao, Kentaro; Imai, Hisao; Chiba, Yasutaka; Sakurai, Toshiharu; Watanabe, Tomohiro; Nishida, Naoshi; Chikugo, Takaaki; Matsumoto, Ippei; Takeyama, Yoshifumi; Kudo, Masatoshi

doi:10.1159/000481234

Cited by 11 publications

(10 citation statements)

References 14 publications

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“…A history of smoking and of acute pancreatitis are well‐established risk factors for pancreatic cancer, but not for the development of worrisome features in IPMN. Some studies suggest smoking accelerates progression of IPMN, and that it predicts invasive IPMN or concomitant pancreatic cancer in resected IPMN, but results are conflicting …”

Section: Discussionmentioning

confidence: 99%

Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Overbeek

Alblas

Gausman

et al. 2019

Aliment Pharmacol Ther

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Summary Background Because most pancreatic intraductal papillary mucinous neoplasms (IPMNs) will never become malignant, currently advocated long‐term surveillance is low‐yield for most individuals. Aim To develop a score chart identifying IPMNs at lowest risk of developing worrisome features or high‐risk stigmata. Methods We combined prospectively maintained pancreatic cyst surveillance databases of three academic institutions. Patients were included if they had a presumed side‐branch IPMN, without worrisome features or high‐risk stigmata at baseline (as defined by the 2012 international Fukuoka guidelines), and were followed ≥ 12 months. The endpoint was development of one or more worrisome features or high‐risk stigmata during follow‐up. We created a multivariable prediction model using Cox‐proportional logistic regression analysis and performed an internal‐external validation. Results 875 patients were included. After a mean follow‐up of 50 months (range 12‐157), 116 (13%) patients developed worrisome features or high‐risk stigmata. The final model included cyst size (HR 1.12, 95% CI 1.09‐1.15), cyst multifocality (HR 1.49, 95% CI 1.01‐2.18), ever having smoked (HR 1.40, 95% CI 0.95‐2.04), history of acute pancreatitis (HR 2.07, 95% CI 1.21‐3.55), and history of extrapancreatic malignancy (HR 1.34, 95% CI 0.91‐1.97). After validation, the model had good discriminative ability (C‐statistic 0.72 in the Mayo cohort, 0.71 in the Columbia cohort, 0.64 in the Erasmus cohort). Conclusion In presumed side branch IPMNs without worrisome features or high‐risk stigmata at baseline, the Dutch‐American Risk stratification Tool (DART‐1) successfully identifies pancreatic lesions at low risk of developing worrisome features or high‐risk stigmata.

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Section: Discussionmentioning

confidence: 99%

Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Overbeek

Alblas

Gausman

et al. 2019

Aliment Pharmacol Ther

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“…In contrast, Kamata et al [15] reported that the risk factors for PDAC, including CP, were not significantly associated with the malignant IPMN like high-grade dysplasia and associated invasive carcinoma.…”

Section: Discussionmentioning

confidence: 88%

Metachronous occurrence of main-duct intraductal papillary mucinous neoplasm (IPMN) and adenocarcinoma in a chronic pancreatitis patient

Jee¹

2022

Medicine

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Rationale: Chronic pancreatitis (CP) is a risk factor for developing pancreatic ductal adenocarcinoma (PDAC). In addition, a patient with partial pancreatectomy for intraductal papillary mucinous neoplasm (IPMN) can also lead to PDAC. In contrast, IPMN is a distinct disease entity, independent of CP, and there have been few reports that CP is the cause of IPMN. To the best of our knowledge, this is the first clinical case report of the metachronous occurrence of main-duct IPMN and PDAC with a 9 and half-year interval in a patient with chronic alcoholic pancreatitis.Patient concerns: A 50-year-old man with a long medical history of recurrent alcoholic pancreatitis and hepatitis over a decade was diagnosed with another episode of acute pancreatitis based on laboratory findings and clinical symptoms. The patient underwent pylorus-preserving pancreaticoduodenectomy (PPPD) for a small nodular lesion in the main duct of the pancreatic head and was diagnosed with main-duct IPMN low-grade dysplasia and associated fibrosing CP. Nine and a half years later, a 59-year-old man lost 7 kg over 3 months and was diagnosed with new-onset diabetes mellitus. Diagnosis:The patient was diagnosed with metachronous, well-differentiated PDAC with concomitant CP. Interventions:The patient underwent radical antegrade modular pancreatosplenectomy (RAMPS) for a small nodular mass in the remnant pancreas.Outcomes: The patient was healthy for 44 months without evidence of tumor recurrence during clinical follow-up examinations including laboratory findings, tumor marker, and imaging studies.Lessons: Early diagnosis of metachronous pancreatic neoplasia in a patient with chronic pancreatitis could be made by correlating newly developed clinical symptoms and signs with careful radiological examinations.

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“…63 Uniquely, having a smoking history is also one of the few valuable predictive factors for malignant IPMN that would thus warrant surgical resection. 64 Cumulative pack-years were higher in patients who had PDAC concomitant with IPMN than in patients with just IPMN, arguing a strong role for smoking induced malignant IPMN. 65 In a study by Zhang et al 66 only patients who were both cigarette smokers and alcohol drinkers were associated with reduced survival from PDAC and the 2 risk factors interact with each other to promote the development of PDAC.…”

Section: The Relationship Between Risk Factors For Pdac and Cigarette Smokingmentioning

confidence: 96%

The Diverse Involvement of Cigarette Smoking in Pancreatic Cancer Development and Prognosis

et al. 2020

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Despite extensive research in the pathogenesis, early detection, and therapeutic approaches of pancreatic ductal adenocarcinoma (PDAC), it remains a devastating and incurable disease. As the global incidence and prevalence of PDAC continue to rise, there is a pressing need to place strong emphasis on its prevention. Although it is widely recognized that cigarette smoking, a potentially modifiable risk factor, has been linked to PDAC development, its contribution to prognosis is still uncertain. Moreover, the mechanistic pathways of PDAC progression secondary to smoking are various and lack a summative narration. Herein, we update and summarize the direct and indirect roles cigarette smoking plays on PDAC development, review literature to conclude the impact cigarette smoking has on prognosis, and postulate a comprehensive mechanism for cigarette smoking-induced PDAC.

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Association between the Risk Factors for Pancreatic Ductal Adenocarcinoma and Those for Malignant Intraductal Papillary Mucinous Neoplasm

Cited by 11 publications

References 14 publications

Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Development of a stratification tool to identify pancreatic intraductal papillary mucinous neoplasms at lowest risk of progression

Metachronous occurrence of main-duct intraductal papillary mucinous neoplasm (IPMN) and adenocarcinoma in a chronic pancreatitis patient

The Diverse Involvement of Cigarette Smoking in Pancreatic Cancer Development and Prognosis

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