{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:34:36Z","timestamp":1782603276971,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2013,10,22]],"date-time":"2013-10-22T00:00:00Z","timestamp":1382400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2013,11]]},"abstract":"Abstract<\/jats:title>Background and Aim<\/jats:title>The evidence for main pancreatic duct intraductal papillary mucinous neoplasms (MPD<\/jats:styled-content>\u2010IPMN<\/jats:styled-content>) malignancy is based predominantly on investigation of resected cases, and the natural history is still unclear. The aim of the present study is to investigate the natural history of MPD<\/jats:styled-content>\u2010IPMN<\/jats:styled-content> and examine potential predictors of disease progression in MPD<\/jats:styled-content>\u2010IPMN<\/jats:styled-content> patients who conformed to \u201chigh\u2010risk stigmata\u201d criteria.<\/jats:p><\/jats:sec>Methods<\/jats:title>This study included consecutive 20 follow\u2010up patients and 19 surgical patients with \u201chigh\u2010risk stigmata\u201d MPD<\/jats:styled-content>\u2010IPMN<\/jats:styled-content>, in whom the diameter of the MPD<\/jats:styled-content> was >\u200910\u2009mm, branch duct was <\u20095\u2009mm, and who underwent clinical follow up for \u2265\u20092 years.<\/jats:p><\/jats:sec>Results<\/jats:title>Among surgical patients, mural nodules and MPD<\/jats:styled-content> diameter of invasive patients were significantly different compared with non\u2010invasive patients. On the other hand, among follow\u2010up patients, univariate analysis revealed the following potential predictors for disease progression: diameter of MPD<\/jats:styled-content>\u2009\u2265\u200915\u2009mm (hazard ratio [HR<\/jats:styled-content>], 20.9; 95% confidence interval [CI<\/jats:styled-content>], 2.59\u2013173.4; P<\/jats:italic>\u2009<\u20090.01); and diffuse lesions of MPD<\/jats:styled-content>\u2010IPMN<\/jats:styled-content> (HR<\/jats:styled-content>, 4.46; 95% CI<\/jats:styled-content>, 1.10\u201318.0; P<\/jats:italic>\u2009=\u20090.04). On the other hand, multivariate analysis identified only diameter of MPD<\/jats:styled-content>\u2009\u2265\u200915\u2009mm (HR<\/jats:styled-content>, 19.2; 95%CI<\/jats:styled-content>, 1.87\u2013198.5; P<\/jats:italic>\u2009=\u20090.01) as a potential predictor of disease progression.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>If MPD<\/jats:styled-content>\u2010IPMN<\/jats:styled-content> patients have other severe complications or reasons for not undergoing surgical treatment, MPD<\/jats:styled-content> diameter\u2009<\u200915\u2009mm, negative cytology, and no mural nodules, conservative clinical follow up for several years may be an option.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.12301","type":"journal-article","created":{"date-parts":[[2013,6,26]],"date-time":"2013-06-26T01:24:10Z","timestamp":1372209850000},"page":"1782-1786","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Potential predictors of disease progression for main\u2010duct intraductal papillary mucinous neoplasms of the pancreas"],"prefix":"10.1111","volume":"28","author":[{"given":"Takeshi","family":"Ogura","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine Osaka Medical College Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Masuda","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine Osaka Medical College Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitaka","family":"Kurisu","sequence":"additional","affiliation":[{"name":"Department of Pathology Osaka Medical College Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoko","family":"Edogawa","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine Osaka Medical College Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Imoto","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine Osaka Medical College Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michihiro","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of General and Gastroenterological Surgery Osaka Medical College Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhisa","family":"Uchiyama","sequence":"additional","affiliation":[{"name":"Department of General and Gastroenterological Surgery Osaka Medical College Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhide","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine Osaka Medical College Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,10,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000126675.59108.80"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.134.10.1131"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200010000-00006"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4265"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-200303000-00014"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000124386.54496.15"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000090023"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2012.04.004"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1255971"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0b013e31820a5975"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2008.04.005"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-010-0343-0"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0b013e3181c81b52"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0b013e3182056a83"},{"key":"e_1_2_6_16_1","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1080\/01621459.1958.10501452","article-title":"Nonparametric estimation from incomplete observations","volume":"53","author":"Kaplan E","year":"1958","journal-title":"J. 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