The Revised Kyoto Criteria and Risk of Malignancy Among Patients With Intraductal Papillary Mucinous Neoplasms

Background & Aims The revised Kyoto guidelines have a new catalog of high-risk stigmata and worrisome features for the risk stratification of intraductal papillary mucinous neoplasms (IPMNs). We aimed to validate the stratification system in terms of short- and long-term risks of pancreatic carcinoma. Methods We included 3,336 patients diagnosed with IPMNs in 2000-2021 and examined short-term (≤ 6 months) and long-term risks of pancreatic carcinoma diagnosis. We used the multivariable competing-risks proportional hazards regression model to calculate subdistribution hazard ratios for long-term incidence of pancreatic carcinoma with adjustment for potential confounders. Results In short-term analyses, pancreatic carcinomas were prevalent predominantly in IPMNs with high-risk stigmata (49% vs. 1.3% and 0.05% in IPMNs with worrisome features and no risk factors, respectively). In long-term analyses of worrisome features, the main pancreatic duct diameter of 5-9.9 mm, acute pancreatitis, and IPMN growth rate of 2.5 mm/year were associated with a high incidence with multivariable subdistribution hazard ratios (95% confidence intervals) of 3.46 (2.04-5.89), 5.65 (1.86-17.2), and 3.83 (2.14-6.86), respectively. An increasing number of worrisome features at baseline was associated with a higher prevalence and incidence of pancreatic carcinoma (P trend < .001). Patients with 1, 2, and 3-4 worrisome features had multivariable subdistribution hazard ratios (95% confidence intervals) for pancreatic cancer incidence of 1.43 (0.93-2.19), 2.17 (1.17-4.05), and 10.1 (4.20-24.5), respectively (vs. no positive feature). Conclusions The revised Kyoto criteria stratify IPMN patients well in terms of the short- and long-term risks of pancreatic carcinoma diagnosis, potentially informing personalized patient management.