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Clinical Course and Risk Factors for Malignant Progression in Intraductal Papillary Mucinous Neoplasms with High-Risk
Sho Hasegawa1, Yusuke Kurita2, Yuma Yamazaki2
1Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. t166064d@yokohama-cu.ac.jp.
Annals of Surgical Oncology
|May 12, 2026
Summary
High-risk intraductal papillary mucinous neoplasms (IPMN) can progress to malignancy. Tumor markers like carbohydrate antigen 19-9 (CA19-9) and fluorodeoxyglucose (FDG) uptake on PET-CT, not just size, predict progression, aiding treatment decisions.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Intraductal papillary mucinous neoplasms (IPMN) with high-risk stigmata (HRS) often require surgical resection.
- Conservative management is sometimes used for HRS-IPMN in elderly or comorbid patients.
- Identifying risk factors for malignant progression in HRS-IPMN is crucial for treatment planning.
Purpose of the Study:
- To evaluate the clinical course of patients with high-risk stigmata IPMN.
- To identify predictors of malignant progression in this patient cohort.
Main Methods:
- Retrospective analysis of 100 patients with HRS-IPMN (2015-2024).
- Patients were divided into surgical (n=63) and observation (n=37) groups.
- Logistic regression identified factors associated with malignant progression.
Main Results:
- Malignant progression occurred in 18% of patients.
- Elevated carbohydrate antigen 19-9 (CA19-9) > 37 U/mL (OR 5.6) and high fluorodeoxyglucose (FDG) uptake (SUV > 3) on PET-CT (OR 4.7) were independent predictors.
- Enhancing mural nodules ≥ 5 mm were not statistically significant predictors.
Conclusions:
- Malignant progression in HRS-IPMN is linked to biological and metabolic markers, not solely morphology.
- Incorporating CA19-9 and FDG-PET findings can refine risk stratification.
- This approach may help avoid unnecessary surgeries in select high-risk patients.
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