Gastrointestinal cancer precursor risk and mortality in pancreatic intraductal papillary mucinous neoplasms: a nationwide cohort study

Abstract

Background and aims

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a precursor of pancreatic cancer. While earlier research has shown a high prevalence of synchronous/metachronous extrapancreatic tumors in IPMN patients, these studies have often been small with retrospective data collection. The aim of the study was to examine absolute and relative risks of non-pancreatic gastrointestinal (GI) cancer precursors and mortality in histologically confirmed IPMN.

Methods

Through the nationwide ESPRESSO histopathology cohort, we retrieved data on IPMN between 1965 and 2016. Each index case was matched to ≤5 general population controls. Through Cox regression, we estimated hazard ratios (HRs) for future GI cancer precursors and death.

Results

A total of 117 patients with IPMN and 539 age- and sex-matched controls were included. Over a median of 2.1 years of follow up, we confirmed two (1.7%) incident GI cancer precursors in IPMN vs. four (0.7%) in controls, corresponding to an HR of 1.89 (95%CI = 0.34–10.55). By contrast, IPMN patients were at increased risk of death (HR 3.61 (95%CI = 1.79–7.27)). The most common cause of death in IPMN was pancreatic cancer (n = 14; 45.2% of all deaths).

Conclusions

We found no association between IPMN and other GI cancer precursors. This argues against comprehensive routine surveillance for other GI cancer precursors in IPMN patients. Mortality was increased in IPMN with pancreatic cancer being the most common cause of death, indicating the need for lifelong follow up in all resected and non-resected patients with IPMN. However, results should be confirmed in larger cohorts.

Keywords:

• IPMN
• cancer
• gastrointestinal
• adenoma
• Barrett

Authors contribution

All authors conceived and designed the study. MV and JFL wrote the first draft of the paper. JFL supervised the project. MV and JFL funded the study. MT carried out the statistics. All authors interpreted the data and contributed to the writing of the paper. All authors revised and approved the final version. JFL takes responsibility for the integrity of the data and the accuracy of the data analyses. JFL is the guarantor of the data.

Ethical approval

This study was approved by the Stockholm Ethics Review Board (2014/1287-31/4 and 2018/972-32).

Disclosure statement

Dr. Ludvigsson has coordinated an unrelated study on behalf of the Swedish IBD quality register (SWIBREG). This study has received funding from the Janssen corporation. Dr Ludvigsson has also received financial support from MSD to develop a paper reviewing national healthcare registers in China. Dr Vujasinovic and Dr Löhr have received lecture fees from Abbott and Viatris. Dr Vujasinovic and Dr Löhr have also received financial support for writing a scientific book from Viatris. All other authors declare that they have no conflicts of interest and nothing to declare.

Grants and financial support

The Swedish Cancer Foundation (JFL).

Data sharing statement

Other researchers can apply for our data through the different Swedish pathology departments, and through the Swedish National Board of Health and Welfare.