Higher volume growth rate is associated with development of worrisome features in patients with branch duct-intraductal papillary mucinous neoplasms

doi:10.12998/wjcc.v10.i17.5667

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Clin Cases. Jun 16, 2022; 10(17): 5667-5679
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5667

Table 1 Baseline and demographic characteristics of patients and cysts

Characteristics		n = 98
Males (%)		33 (33.7)
Females (%)		65 (66.3)
Median age at diagnosis (IQR)		69 (63-75)
Familial history (%)		9 (9.2)
History of diabetes (%)		16 (16.3)
Diabetes onset during follow-up (%)		0 (0.0)
Median follow-up [mo (IQR)]		40.5 (24-72)
Former smokers (%)		14 (14.3)
Active smokers (%)		8 (8.1)
Never smoked (%)		76 (77.6)
Multifocal		57 (58.2)
Largest cyst localization	Head (%)	44 (44.9)
	Isthmus/body (%)	40 (40.8)
	Tail (%)	14 (14.3)
Median cyst size	a [mm (IQR)]	9 (6-15)
	b [mm (IQR)]	10 (6.75-16)
	c [mm (IQR)]	10 (6-16)
	Volume [cm³ (IQR)]	0.54 (0.17-1.65)
EUS		19 (19.4)
Median time to EUS (IQR)		6 (0-31.5)
FNA (%)		9 (47.4)
Cyst fluid amylases [IU/L (IQR)], n = 5		289 (69.25-1725.25)
Cyst fluid CEA [IU/L (IQR)], n = 6		166 (8.55-24062.75)
Serum CA19.9 [IU/L (IQR)], n = 25		25.2 (6.1-58.7)
Serum CEA [IU/L (IQR)], n = 22		2.15 (1.27-2.92)

CA19.9: Carbohydrate antigen 19.9; CEA: Carcinoembriogenic antigen; EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; IQR: Interquartile range; IU: International units; a: Sagittal (antero-posterior); b: Transversal (latero-lateral); c: Coronal (cranio-caudal).

Table 2 Baseline and demographic characteristics of patients and cysts: subgroups

		Non-worrisome features (n = 88)	Worrisome features (n = 10)	P value
Males (%)		31 (35.2)	2 (20.0)	0.540234
Females (%)		57 (64.8)	8 (80.0)	0.540234
Median age at diagnosis (IQR)		70 (63.5-74.75)	67 (59.75-76.25)	0.58232
Familial history (%)		8 (9.1)	1 (10.0)	0.628786
History of diabetes (%)		14 (15.9)	2 (20.0)	0.904665
Diabetes onset during follow-up (%)		0 (0.0)	0 (0.0)	-
Median follow-up [mo (IQR)]		37.5 (23.25-71)	69.5 (46.5-94)	0.01828
Former smokers (%)		11 (12.5)	3 (30.0)	0.306885
Active smokers (%)		8 (9.1)	0 (0.0)	0.738111
Never smoked (%)		69 (78.4)	7 (70.0)	0.83833
Multifocal		52 (59.1)	5 (50.0)	0.830551
Largest cyst localization	Head (%)	39 (44.3)	5 (50.0)	0.994538
	Isthmus/body (%)	35 (39.8)	5 (50.0)	0.776364
	Tail (%)	14 (15.9)	0 (0.0)	0.746616
Median cyst size	a [mm (IQR)]	9 (6-13)	19 (11.25-21.25)	0.0035
	b [mm (IQR)]	10 (6-15)	18 (10.75-20.75)	0.00652
	c [mm (IQR)]	9.5 (6-15)	22.5 (12-27.65)	0.00424
EUS		14 (15.9)	5 (50.0)	0.030618
Median time to EUS (IQR)		3 (0-18.25)	29 (5.5-69.5)	0.22628
Serum CA19.9 [IU/L (IQR)], n = 25		6.2 (5.6-24.2)	23.8 (6.2-37.9)	0.1556
Serum CEA [IU/L (IQR)], n = 22		2.15 (1.28-2.93)	2.15 (1.55-2.75)	0.93624

IQR: Interquartile range; a: Sagittal (antero-posterior); b: Transversal (latero-lateral); c: Coronal (cranio-caudal).

Table 3 Patients who underwent surgery

	Sex, age	Final cyst volume (cm³)	Growth rate (cm³/yr)	MPD (mm)	Location	CA19.9 (IU/L)	Time to surgery (mo)	Histopathology
Patient A	F, 68	28.73	33.91	< 5	Isthmus	33.2	85	LGD
Patient B	F, 74	14.70	24.27	< 5	Head	22.5	65	LGD

CA19.9: Carbohydrate antigen 19.9; F: Female; LGD: Low-grade dysplasia; MPD: Main pancreatic duct.

Table 4 Baseline cysts size

	All (n = 98)	Non-worrisome features (n = 88)	Worrisome features (n = 10)	P value
a [mm (IQR)]	9 (6-15)	9 (6-13)	19 (11.25-21.25)	0.0035
b [mm (IQR)]	10 (6.75-16)	10 (6-15)	18 (10.75-20.75)	0.00652
c [mm (IQR)]	10 (6-16)	9.5 (6-15)	22.5 (12-27.65)	0.00424
volume [cm³ (IQR)]	0.54 (0.17-1.65)	0.45 (0.15-1.28)	5.28 (1.10-6.30)	0.00222

IQR: Interquartile range; a: Sagittal (antero-posterior); b: Transversal (latero-lateral); c: Coronal (cranio-caudal).

Table 5 Final cysts size

	All (n = 98)	Non-worrisome features (n = 88)	Worrisome features (n = 10)	P value
a [mm (IQR)]	9 (6-16)	9 (6-13.75)	23 (13.5-27.5)	0.00288
b [mm (IQR)]	12 (7-18)	11 (7-16.75)	28 (19.25-37.5)	0.00054
c [mm (IQR)]	11 (7-18)	10.5 (6.25-16)	29 (15.75-38.75)	0.0003
volume [cm³ (IQR)]	0.58 (1.76-2.02)	0.52 (0.17-1.63)	10.17 (2.72-19.36)	0.0005

IQR: Interquartile range; a: Sagittal (antero-posterior); b: Transversal (latero-lateral); c: Coronal (cranio-caudal).

Table 6 Total cysts growth

	All (n = 98)	Non-worrisome features (n = 88)	Worrisome features (n = 10)	P value
a [mm (IQR)]	0 (-0.25-2)	0 (-0.75-1.75)	2 (-0.5-8.75)	0.0601
b [mm (IQR)]	0 (0-3)	0 (0-2)	10 (-0.25-14.25)	0.01016
c [mm (IQR)]	0 (0-3)	0 (-1-2)	5 (3.25-14)	0.00008
Volume [cm³ (IQR)]	0.02 (-0.01-0.70)	0 (-0.03-0.24)	4.01 (0.83-13.87)	< 0.00001
Volume increased (%)	28 (28.6)	18 (20.4)	10 (100.0)	< 0.00001
Volume unchanged or reduced (%)	70 (71.4)	70 (79.6)	0 (0.0)	< 0.00001

IQR: Interquartile range; a: Sagittal (antero-posterior); b: Transversal (latero-lateral); c: Coronal (cranio-caudal).

Table 7 Yearly cysts growth rate

	All (n = 98)	Non-worrisome features (n = 88)	Worrisome features (n = 10)	P value
a [mm/yr (IQR)]	0 (-0.04-0.73)	0 (-0.11-0.6)	0.63 (-0.11-1.275)	0.14156
b [mm/yr (IQR)]	0 (0-1.33)	0 (0-1.09)	1.55 (-0.53-3.52)	0.0394
c [mm/yr (IQR)]	0 (0-0.99)	0 (-0.29-0.71)	1.96 (0.64-2.47)	0.00152
Volume [cm³/yr (IQR)]	0 (-0.01-0.27)	0 (-0.02-0.17)	1.12 (0.28-2.65)	0.0001

a: Sagittal (antero-posterior); b: Transversal (latero-lateral); c: Coronal (cranio-caudal). IQR: Interquartile range.

Table 8 First-year cysts growth and development of worrisome features

	All (n = 74)	Non-worrisome features (n = 64)	Worrisome features (n = 10)	P value
a [mm (IQR)]	0 (0-0.56)	0 (0-0.5)	0.47 (-0.11-1.1)	0.22628
b [mm (IQR)]	0 (0-1.13)	0 (0-0.14)	0.4 (-1.12-2.81)	0.64552
c [mm (IQR)]	0 (0-0.94)	0 (0-0.74)	1.4 (0-2.47)	0.00932
Volume [cm³ (IQR)]	0 (-0.02-0.18)	0 (-0.04-0.08)	0.46 (0-1.62)	0.00634
Volume increased (%)	35 (47.3)	28 (43.7)	7 (70.0)	0.227942
Volume unchanged or reduced (%)	39 (52.7)	36 (56.3)	3 (30.0)	0.227942

a: Sagittal (antero-posterior); b: Transversal (latero-lateral); c: Coronal (cranio-caudal). IQR: Interquartile range.

Citation: Innocenti T, Danti G, Lynch EN, Dragoni G, Gottin M, Fedeli F, Palatresi D, Biagini MR, Milani S, Miele V, Galli A. Higher volume growth rate is associated with development of worrisome features in patients with branch duct-intraductal papillary mucinous neoplasms. World J Clin Cases 2022; 10(17): 5667-5679
URL: https://www.wjgnet.com/2307-8960/full/v10/i17/5667.htm
DOI: https://dx.doi.org/10.12998/wjcc.v10.i17.5667