2008 Annual Meeting Abstracts
National Patterns in the Management of Intraductal Papillary Mucinous Neoplasm: Are We Making a Difference?
Jessica P. Simons, MD, Sing Chau Ng, MS, Shimul A. Shah, MD, Theodore P. McDade, MD, Giles F. Whalen, MD, Jennifer F. Tseng, MD, MPH.
University of Massachusetts Medical School, Worcester, MA, USA.
Objective: To evaluate national resection rates and associated survival for malignant intraductal papillary mucinous neoplasm (IPMN).
Design: Retrospective observational study.
Setting: Surveillance Epidemiology and End Results, 1988-2003.
Patients: 1834 cases of malignant IPMN were identified using histology codes and tumor site.
Main Outcome Measure: Receipt of resection. Age-adjusted incidence rates were calculated. Cochran Armitage tests evaluated trends over time. Predictors of resection were evaluated using χ2 and logistic regression. Kaplan-Meier curves and Cox models were constructed to evaluate predictors of survival.
Results: Of 1834 patients, 209 (11.4%) underwent resection. Annual age-adjusted incidence decreased over the study time-course (p<0.05), while the annual proportion of patients presenting with localized lesions (vs all other stages) and the proportion being resected increased (p<0.05). Predictors of resection on multivariate analysis included localized stage [vs distant, adjusted odds ratio (OR) 31; 95% confidence interval (CI) 17-56] and more recent diagnosis [referent 1988-1991; 2000-2003, OR 3.0 (95%CI 1.7-5.3)]. Median survival for resected patients was 16 months versus 3 months without resection (p<0.0001). After adjusting for age, gender, stage, year, and tumor location, surgical resection remained a significant predictor of survival [hazard ratio 0.44 (95%CI 0.36-0.54), p<0.0001].
Conclusions: In this population-based cohort, detection of malignant IPMNs is decreasing, with an increasing proportion of patients diagnosed at local stages and undergoing resection. Increased awareness of IPMN may be contributing to earlier detection, which might include benign/premalignant lesions, and greater utilization of resection for appropriate candidates; thus, we may be improving survival for this most treatable form of pancreatic cancer.