Preoperative Predictive Factors Of Malignancy In Pancreatic Intraductal Papillary Mucinous Neoplasm Patients

Aim:This study attempts to identify preoperative predictive factors of malignancy in IPMN.Method:From2002to2014, a retrospective review of clinical data for a total of55IPMNs patients was carried out. Based on a set of26factors, an attempt was made to predict the factors that could indicate malignancy in patients preoperatively. A simultaneous analysis for invasiveness was performed. Univariate analysis, logistic regression analysis and ROC analysis were calculated. Short term survival rate was also calculated for follow up patients.Result:Preoperative AST (P<0.004) and ALT (P<0.002) levels, MPD diameter>5mm (P<0.002), the cyst size>3cm (P<0.033), enhanced solid component (P<0.026) and abrupt change in MPD caliber with distal pancreatic atrophy (P<0.015) were statistically significant for malignancy. Alcohol consumption (P<0.046), preoperative AST (P<0.031)and ALT (P<0.043) levels, MPD diameter≥5mm (P<0.015), the cyst size≥3cm (P<0.019), enhanced solid component (P<0.033) and abrupt change in MPD caliber with distal pancreatic atrophy (P<0.046), were statistically significant for invasiveness. On ROC analysis, for both malignancy and invasiveness, MPD diameter had largest area under curve,0.791(P<0.002,95%CI:0.668-0.913) and0.772(P<0.010,95%CI:0.635-0.909), respectively.Conclusion:1. Cyst size≥3cm, MPD diameter≥5mm, enhanced solid component and abrupt change in MPD with distal pancreas atrophy and increased preoperative ALT and AST levels were associated with malignancy, with MPD diameter being most predictive factor for both malignancy and invasiveness.2. Interestingly, alcohol consumption was statistically significant for invasive IPMN.3. Alcohol consumption in regard to invasiveness of IPMN warrants further studies as it might provide a new window regarding the etiology of the IPMN and/or invasiveness of IPMN in patients.