Intraductal Papillary Mucinous Neoplasms: Risk of Pancreatic Cancer

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In a retrospective cohort study reported in JAMA Network Open, de la Fuente et al found that the risk of pancreatic cancer in patients with Fukuoka criteria–negative intraductal papillary mucinous neoplasms (F-N IPMNs) did not differ from that in patients without IPMNs. In addition, the small proportion of patients with pancreatic cancer associated with IPMNs (IPMN-PC) had better survival vs patients with non–IPMN PC.

Study Details

The study was conducted in Olmsted County, Minnesota, using the Rochester Epidemiology Project (REP). Patients aged ≥ 50 years who underwent abdominal computed tomography (CT) scans between 2000 and 2015 were randomly selected (CT cohort). All patients from the REP diagnosed with pancreatic cancer between 2000 and 2019 were included.

Key Findings

The CT cohort included 2,114 patients. IPMNs were identified in 231 patients (10.9%, 95% confidence interval [CI] = 9.7%–12.3%). Of these, 5 were Fukuoka high-risk (F-HR) IPMNs (2.2%), 39 worrisome (F-W) IPMNs (16.9%), and 187 F-N IPMNs (81.0%).

After a median follow-up of 12.0 years (interquartile range = 8.1–15.3 years), four patients developed pancreatic cancer: two in the in F-HR group and two in the F-N group. The pancreatic cancer incidence rate per 100 person-years was 34.06 for F-HR IPMNs, < 0.01 for F-W IPMNs, 0.16 for F-N IPMNs, and 0.11 for non-IPMNs (overall P < .001). No significant difference was observed between patients with F-N IPMNs and those with no IPMNs (P = .62).

The pancreatic cancer cohort included 320 patients. Compared with 284 patients with non-IPMN pancreatic cancer, 31 with IPMN pancreatic cancer were older (mean age = 76.9 vs 71.3 years, P = .02), more likely to have undergone surgical resection (45.2% vs 21.1%, P = .003), and more likely to have nonmetastatic pancreatic cancer at diagnosis (64.5% vs 46.8%, P = .047). In analysis adjusted for age, sex, and stage, patients with IPMN pancreatic cancer had improved overall survival vs those with non-IPMN pancreatic cancer (adjusted hazard ratio = 0.62, 95% CI = 0.40–0.94, P = .03).

The investigators concluded, “In this study, CTs identified IPMNs in approximately 10% of patients aged 50 years or older. Pancreatic cancer risk in patients with F-N IPMNs was low and not different compared with patients without IPMNs; approximately 10% of patients with pancreatic cancer had IPMN pancreatic cancer, and they had better survival compared with patients with non-IPMN pancreatic cancer.”

Shounak Majumder, MD, of the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, is the corresponding author for the JAMA Network Open article.

Disclosure: The study was supported by the National Center for Advancing Translational Sciences, National Institute on Aging, a gift to the Mayo Clinic for the Pancreatic Cancer Early Detection Research Program from the Centene Charitable Foundation, National Institutes of Health, and others. For full disclosures of the study authors, visit

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