[Malignancy predictive factors in pancreatic intraductal papillary mucinous neoplasm]. / Factores predictivos de malignidad en la neoplasia mucinosa papilar intraductal de páncreas.

BACKGROUND AND OBJECTIVE: Intraductal papillary mucinous neoplasm (IPMN) is a premalignant lesion of the pancreas. Its natural history is not well known. We evaluated the characteristics and predictor factors of malignancy of IPMN. PATIENTS AND METHOD: A retrospective analysis was performed in 88 patients diagnosed with IPMN between January 1997 and December 2008. The diagnosis was done by abdominal computed tomography (CT), pancreatic-magnetic resonance imaging (MRI) and/or endoscopic ultrasound (EUS). Gender, age, symptoms, origin, location, CA 19.9 serum levels, size of tumours and nodules by imaging techniques, type of surgery, malignancy and survival were evaluated. Nine pre-surgical variables were selected, and univariate and multivariate analysis to identify independent prognostic factors of malignancy were performed. RESULTS: The mean age was 64 years and 53% were men. 39% of tumours were incidental. 50% had their origin on the main pancreatic duct, 37% on collateral branchs and 13% were multifocal. 68% patients were operated: 42% had malignant neoplasms (32% carcinoma in situ and 68% invasive). Twelve patients died (1 benign, 1 in situ and 10 invasive). Univariate and multivariate analysis identified the symptoms and the tumour size (≥ 22 mm [median of our serie] and ≥ 30 mm [size accepted in literature]) as independent predictor factors of malignancy. CONCLUSIONS: Many IPMN are incidental findings. The presence of symptoms and size of the tumour are independent prognostic factors of malignancy and they should be considered to decide therapeutic actions.

Factores predictivos de malignidad en la neoplasia mucinosa papilar intraductal de páncreas / Malignancy predictive factors in pancreatic intraductal papillary mucinous neoplasm

Fundamento y objetivo: La neoplasia mucinosa papilar intraductal (NMPI) es una lesión pancreática premaligna cuya historia natural no es bien conocida. Se han analizado las características de las NMPI atendidas en nuestro hospital e identificado factores predictivos de malignidad.Pacientes y método: Análisis retrospectivo de 88 pacientes con NMPI diagnosticados por tomografía computarizada (TC), colangio-pancreatografía por resonancia magnética (CPRM) y/o ultrasonografía endoscópica (USE), de enero de 1997 a diciembre de 2008. Se evaluaron: edad, sexo, forma de presentación, origen, localización, CA 19.9 sérico, tamaño del tumor y existencia de nódulos según técnicas de imagen, tipo de cirugía, malignidad y supervivencia. Se seleccionaron nueve variables prequirúrgicas y se realizó un análisis uni y multivariante para identificar factores predictivos independientes de malignidad.Resultados: La edad media de los pacientes fue de 64 años y el 53% eran varones. El 39% fueron diagnosticados por un hallazgo casual. El 50% tenían su origen en el conducto de Wirsung, el 37% en ramas colaterales y un 13% eran mixtos. Fueron operados un 68%; de éstos, el 42% fueron tumores malignos (32% carcinoma “in situ” y 68% invasivos). Fallecieron 12 pacientes (1 benigno, 1 “in situ” y 10 invasivos). Los análisis uni y multivariante identificaron como factores predictivos independientes de malignidad la presencia de síntomas y el tamaño del tumor (≥ 22mm [mediana de nuestra serie] y ≥ 30mm [tamaño aceptado en la literatura]). Conclusión: Muchas NMPI son hallazgos casuales. La presencia de síntomas y el tamaño del tumor son factores predictivos independientes de malignidad y deben tenerse en cuenta en el momento de decidir la actitud terapéutica (AU)

Background and objective:Intraductal papillary mucinous neoplasm (IPMN) is a premalignant lesion of the pancreas. Its natural history is not well known. We evaluated the characteristics and predictor factors of malignancy of IPMN. Patients and method: A retrospective analysis was performed in 88 patients diagnosed with IPMN between January 1997 and December 2008. The diagnosis was done by abdominal computed tomography (CT), pancreatic-magnetic resonance imaging (MRI) and/or endoscopic ultrasound (EUS). Gender, age, symptoms, origin, location, CA 19.9 serum levels, size of tumours and nodules by imaging techniques, type of surgery, malignancy and survival were evaluated. Nine pre-surgical variables were selected, and univariate and multivariate analysis to identify independent prognostic factors of malignancy were performed. Results: The mean age was 64years and 53% were men. 39% of tumours were incidental. 50% had their origin on the main pancreatic duct, 37% on collateral branchs and 13% were multifocal. 68% patients were operated: 42% had malignant neoplasms (32% carcinoma in situ and 68% invasive). Twelve patients died (1 benign, 1 in situ and 10 invasive). Univariate and multivariate analysis identified the symptoms and the tumour size (≥ 22mm [median of our serie] and ≥ 30mm [size accepted in literature]) as independent predictor factors of malignancy. Conclusions: Many IPMN are incidental findings. The presence of symptoms and size of the tumour are independent prognostic factors of malignancy and they should be considered to decide therapeutic actions (AU)