Risk Factor and Prediction Model for Malignant Transformation in Pancreatic Intraductal Papillary Mucinous Neoplasm

Pancreatic intraductal papillary mucinous neoplasms (IPMN) are precursors to pancreatic cancer, with an increasing incidence due to advances in imaging techniques. This study aimed to identify risk factors for malignant transformation in IPMN and develop a predictive model using data from a large medical center in western China.

Patients with IPMN admitted to West China Hospital between January 2010 and February 2022 were included in this study. They were divided into benign and malignant. Characteristic parameters and laboratory results were collected. The training set and test set were randomly divided at a ratio of 7:3. Least absolute shrinkage and selection operator regression was used to select potential prognostic factors. A nomogram was developed by logistic regression. Receiver operating characteristic curves and calibration curves were used to evaluate the model's predictive performance.

We retrospectively analyzed 182 patients, identifying six independent predictors of malignancy: classification, cyst wall thickening, abrupt changes in main pancreatic duct caliber, maximum tumor diameter, maximum main pancreatic duct diameter, and lnCA19-9. We developed a nomogram with an area under the curve of 0.86 in the training set and 0.81 in the test set. The model showed strong predictive ability, providing a valuable tool for clinicians to guide preoperative decision-making.

Our study offers the first predictive model for malignant IPMN in western China and highlights the importance of comprehensive risk assessment, incorporating clinical, imaging, and laboratory data.