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Smoking Is Not Associated with Severe Dysplasia or Invasive Carcinoma in Resected Intraductal Papillary Mucinous Neoplasms

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are precursor lesions that progress to invasive cancer through progressively worsening dysplasia. Although smoking is an established risk factor for pancreatic adenocarcinoma, potential associations with IPMN grade of dysplasia remain unclear.

Methods

Pancreatic resections for IPMN from 1995 to 2013 were retrospectively reviewed. A total of 446 patients in which the smoking status was documented were identified.

Results

Smoking history was positive in 47 % of patients. Of smokers, 50 % had branch-duct, 14 % had main-duct, and 36 % had mixed-type IPMN. Patients with main-duct IPMN were more commonly smokers (65 %), compared to smoking history in 46 % with mixed and 44 % with branch-duct IPMN (p = 0.03). High-grade dysplasia occurred in 25 % of smokers and 21 % of nonsmokers (p = 0.32), and invasive carcinoma in 25 % of smokers and 25 % nonsmokers (p = 0.95). On multivariate analysis, duct size was independently associated with high-grade dysplasia (OR = 3.17, 95 %CI = 1.79–5.64, p < 0.001). Presence of mural nodules (OR = 3.34, 95 %CI = 1.82–6.12, p < 0.001), duct size (OR = 3.87, 95 %CI = 2.21–6.75, p < 0.001), and symptoms (OR = 7.10, 95 %CI = 3.80–13.08, p < 0.001), but not smoking history (OR = 1.10, 95 %CI = 0.64–1.88, p = 0.73), were independent predictors of invasive carcinoma. Median overall survival was 70 months for smokers and 88 months for nonsmokers (p = 0.68).

Conclusion

Positive smoking history correlated with duct type classification but does not appear to be a risk factor for harboring high-grade dysplasia or invasive carcinoma in IPMNs.

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Funding

Supported by NIH SPORE grant CA62924

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Authors and Affiliations

  1. Departments of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA

    Neda Rezaee, Saami Khalifian, John L. Cameron, Timothy M. Pawlik, Martin A. Makary, Anne Marie Lennon, Christopher L. Wolfgang & Matthew J. Weiss

  2. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timothy M. Pawlik, Ralph H. Hruban, Christopher L. Wolfgang & Matthew J. Weiss

  3. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ralph H. Hruban & Christopher L. Wolfgang

  4. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Elliot K. Fishman

  5. Department of Gastroenterology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Anne Marie Lennon

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  1. Neda Rezaee
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Correspondence to Matthew J. Weiss.

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Rezaee, N., Khalifian, S., Cameron, J.L. et al. Smoking Is Not Associated with Severe Dysplasia or Invasive Carcinoma in Resected Intraductal Papillary Mucinous Neoplasms. J Gastrointest Surg 19, 656–665 (2015). https://doi.org/10.1007/s11605-014-2714-y

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  • DOI: https://doi.org/10.1007/s11605-014-2714-y

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