Mucus is a predictor of better prognosis and survival in patients with intraductal papillary mucinous tumor of the pancreas

The aim of our study was to examine the case histories of patients with intraductal papillary mucinous tumor (IPMT) treated with resection to determine predictors of prognosis. Between 1989 and 2000, all patients treated with pancreatic resection for IPMT (n=63) were analyzed. The diagnosis of IPMT was made using the surgical specimen and the World Health Organization definition. Predictors were determined using univariate and multivariate analysis. The pathologic findings were benign (n=30), carcinoma in situ (CIS; n=5), and invasive carcinoma (n=28). After univariate analysis, predictors of malignancy (invasive plus CIS) were jaundice (odds ratio=10.32), elevated serum CA19-9 (odds ratio=15.0), any abnormal liver function test (odds ratio=7.69), and p53 overexpression. The only predictor of benign disease was gross mucus observed during endoscopy (odds ratio=4.35). After multivariate analysis, predictors of malignancy were any abnormal liver function test (odds ratio=5.09) and p53 overexpression, whereas the only predictor of benign disease was still gross mucus (odds ratio=5.88). Actuarial 3- and 5-year survival for benign disease was 95% and 83% and for malignant disease 52% and 44%, respectively (P=0.0048). Survival curves also favored p53-negative tumors vs. p53-positive tumors (P=0.0055). In the 33 patients with malignant disease (mean follow-up time=35 months), the presence of gross mucus was a predictor of prolonged survival after univariate and multivariate analysis (odds ratio=4.34 and 4.55, respectively), whereas alcohol abuse was a predictor of poor survival (odds ratio=3.41 and 3.60, respectively). Gross mucus observed during endoscopy is a predictor of benign IPMT and, within the group with malignant IPMT; the presence of gross mucus was associated with better survival. Survival was also strongly associated with either benign IPMT or negative staining for p53 overexpression.