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 Journal Article


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.
Article Title: 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
Abstract: 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 >3.0cm, 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. © 2016 Wolters Kluwer Health, Inc.
Keywords: adolescent; adult; aged; aged, 80 and over; middle aged; cancer surgery; retrospective studies; young adult; major clinical study; clinical trial; cancer patient; pancreatic neoplasms; cancer staging; follow up; follow-up studies; neoplasm staging; cancer grading; preoperative evaluation; prospective study; prospective studies; pancreas; tumor volume; gastrointestinal symptom; ca 19-9 antigen; intraductal papillary mucinous tumor; adenocarcinoma, mucinous; carcinoma, pancreatic ductal; carcinoma, papillary; calibration; cohort analysis; pathology; validation study; retrospective study; high risk patient; age; pancreas carcinoma; preoperative period; nomograms; multicenter study; pancreas tumor; predictive value of tests; pancreatectomy; jaundice; invasive carcinoma; neoplasm invasiveness; papillary carcinoma; colloid carcinoma; nomogram; predictive value; roc curve; dysplasia; receiver operating characteristic; sex; intermediate risk patient; intraductal papillary mucinous neoplasm; tumor invasion; independent variable; ipmn; low risk patient; visceral pain; body weight disorder; very elderly; cancer; humans; human; male; female; priority journal; article; the pancreatic surgery consortium
Journal Title: Annals of Surgery
Volume: 267
Issue: 1
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2018-01-01
Start Page: 157
End Page: 163
Language: English
DOI: 10.1097/sla.0000000000002015
PUBMED: 28079542
PROVIDER: scopus
PMCID: PMC5565720
DOI/URL:
Notes: Article -- Export Date: 1 February 2018 -- Source: Scopus
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MSK Authors
  1. Ronald P DeMatteo
    599 DeMatteo
  2. Mithat Gonen
    713 Gonen
  3. Peter Allen
    440 Allen
  4. William R Jarnagin
    590 Jarnagin
  5. T Peter Kingham
    288 Kingham
  6. Anne Austin Eaton
    115 Eaton
  7. Marc   Attiyeh
    22 Attiyeh
  8. Ruqayyah Batts
    1 Batts