Long‐Term Surveillance for Pancreatic Carcinoma Among Patients With Branch‐Duct Intraductal Papillary Mucinous Neoplasms

Background Branch‐duct intraductal papillary mucinous neoplasms (BD‐IPMNs) are characterized by a relatively slow progression to malignant transformation. We aimed to evaluate the natural history of BD‐IPMNs over 10 years, focusing on clinical changes associated with malignancy and identifying predisposing factors. Methods This retrospective cohort study included 308 patients with BD‐IPMN monitored for up to 10 years to evaluate the development of pancreatic carcinoma. Results The cohort comprised 308 patients with a median follow‐up of 67.2 months (range: 6–234). Of these, 197 had long‐term follow‐up data (≥ 5 years). At 5 years, the cumulative incidence of pancreatic carcinoma was 2.1%, including 0.7% for IPMN‐derived invasive carcinoma and 1.4% for de novo pancreatic ductal adenocarcinoma (PDAC). At 10 years, the cumulative incidence increased to 5.5%, with 2.7% for IPMN‐derived carcinoma and 2.9% for de novo PDAC. In multivariate analysis, cyst wall thickening (odds ratio [OR]: 23.471; 95% confidence interval [CI]: 5.617–98.072; p < 0.001) and rapid cyst growth (OR: 9.761; 95% CI: 1.145–82.431; p = 0.037) were independently associated with carcinoma. In separate analyses, cyst wall thickening was the only factor independently associated with both IPMN‐derived invasive carcinoma (OR: 41.765; 95% CI: 3.992–436.943; p = 0.002) and de novo PDAC (OR: 10.000; 95% CI: 1.570–63.708; p = 0.015). Conclusions The cumulative incidence of both IPMN‐derived invasive carcinoma and de novo PDAC reached 5.5% at 10 years. Cyst wall thickening was identified as an independent risk factor. Larger studies are warranted to refine risk stratification and optimize surveillance strategies.