Development and Validation of a Multi-institutional Preoperative Nomogram for Predicting Grade of Dysplasia in Intraductal Papillary Mucinous Neoplasms (IPMNs) of the Pancreas: A Report from The Pancreatic Surgery Consortium
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OBJECTIVE: Previous nomogram models for patients undergoing resection of intraductal papillary mucinous neoplasms (IPMNs) have been relatively small single-institutional series. Our objective was to improve upon these studies by developing and independently validating a new model using a large multiinstitutional dataset. SUMMARY BACKGROUND DATA: IPMNs represent the most common radiographically identifiable precursor lesions of pancreatic cancer. They are a heterogenous group of neoplasms in which more accurate markers of high-grade dysplasia or early invasive carcinoma could help avoid unnecessary surgery in 1 case and support potentially curative intervention (resection) in another. METHODS: Prospectively maintained databases from 3 institutions were queried for patients who had undergone resection of IPMNs between 2005 and 2015. Patients were separated into main duct [main and mixed-type (MD)] and branch duct (BD) types based on preoperative imaging. Logistic regression modeling was used on a training subset to develop 2 independent nomograms (MD and BD) to predict low-risk (low- or intermediate-grade dysplasia) or high-risk (high-grade dysplasia or invasive carcinoma) disease. Model performance was then evaluated using an independent validation set. RESULTS: We identified 1028 patients who underwent resection for IPMNs [MD: n = 454 (44%), BD: n = 574 (56%)] during the 10-year study period. High-risk disease was present in 487 patients (47%). Patients with high-risk disease comprised 71% and 29% of MD and BD groups, respectively (P <0.0001). MD and BD nomograms were developed on the training set [70% of total (n = 720); MD: n = 318, BD: n = 402] and validated on the test set [30% (n = 308); MD: n = 136, BD: n = 172]. The presence of jaundice was almost exclusively associated with high-risk disease (57 of 58 patients, 98%). Cyst size >3.0 cm, solid component/mural nodule, pain symptoms, and weight loss were significantly associated with high-risk disease. C-indices were 0.82 and 0.81 on training and independent validation sets, respectively; Brier scores were 0.173 and 0.175, respectively. CONCLUSIONS: For patients with suspected IPMNs, we present an independently validated model for the prediction of high-risk disease.
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The Pancreatic Surgery Consortium's logistic regression model based on patient characteristics and IPMN imaging features showed significant stratification between low-risk and high-risk groups for recurrence of high-grade dysplasia or invasive cancer.
“Their logistic regression model to assess the risk of high-grade dysplasia or invasive carcinoma was based on patient characteristics and IPMN imaging features and showed significant stratification between low-risk and high-risk groups.160”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [160]
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- Authors
- Attiyeh, M. A., Fernández-del Castillo, C., Al Efishat, M., Eaton, A. A., Gönen, M., Batts, R., Pergolini, I., Rezaee, N., Lillemoe, K. D., Ferrone, C. R., Mino-Kenudson, M., Weiss, M. J., Cameron, J. L., Hruban, R. H., D’Angelica, M. I., DeMatteo, R. P., Kingham, T. P., Jarnagin, W. R., Wolfgang, C. L., & Allen, P. J.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Harvard University (US)
- Johns Hopkins University (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Attiyeh, Marc A.
- Batts, Ruqayyah
- DeMatteo, Ronald P.
- Kingham, T. Peter
- Jarnagin, William R.
- Allen, Peter J.
- ORCID
- Venue
- Annals of Surgery
- Published
- 2018-01
- Volume
- 267
- Issue
- 1
- Pages
- 157-163
- ISSN
- 0003-4932 (ISSN-L)
- PMC
- PMC5565720
- OpenAlex
- W2522795941
- Cited by
- 146
- References
- 21
- Citations by year
- 2026: 16 · 2025: 13 · 2024: 17 · 2023: 18 · 2022: 14 · 2021: 21 · 2020: 21 · 2019: 13 · 2018: 9 · 2017: 4
- FWCI
- 4.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01CA182076, P30CA008748)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Surgery › Cholangiocarcinoma and Gallbladder Cancer Studies
- Keywords
- intraductal papillary mucinous neoplasm, pancreatic IPMN, high-grade dysplasia, invasive carcinoma, preoperative nomogram, pancreatic resection, main duct IPMN, branch duct IPMN, jaundice, cyst size, solid component, risk prediction, pancreatic cancer precursor lesions, multi-institutional validation, prognostic factors, avoiding unnecessary surgery, weight loss
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Adenocarcinoma, Mucinous, Carcinoma, Papillary, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Pancreatectomy, Pancreatic Neoplasms, Predictive Value of Tests, Prospective Studies, Retrospective Studies, ROC Curve, Carcinoma, Pancreatic Ductal, Nomograms, Young Adult, Preoperative Period
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