{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:18:51Z","timestamp":1789532331477,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>Main pancreatic duct (MPD)\u2010involved intraductal papillary mucinous neoplasms (IPMNs) carry a significant risk of malignant transformation. However, the long\u2010term malignancy outcomes and the effects of dynamic changes in MPD diameter and other dynamic predictors remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort study included patients diagnosed with MPD\u2010involved IPMNs between\u20092010 and 2023 at eight university hospitals in South Korea. All patients underwent surveillance every 6 to 12\u2009months, which included clinical assessments, tumor marker testing, and imaging studies. Malignancy was confirmed through surgical pathology, endoscopic tissue acquisition, or evidence of radiologic progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 168 patients, 30 (17.8%) developed malignancy during a median 4.0\u2010year follow\u2010up (IQR, 2.1\u20137.0), yielding an annual incidence of 4.5%. Cumulative incidences of malignancy were 7.7% at 2\u2009years, 14.3% at 4\u2009years, and 14.9% at 6\u2009years. The strongest predictor of malignancy was an MPD growth rate \u2265\u20092\u2009mm\/year (odds ratio [OR]: 33.039,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), which also remained significant in Cox regression (hazard ratio: 45.356, p\u2009&lt;\u20090.001). The emergence of new worrisome features (OR: 3.849,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036) and high\u2010risk stigmata (OR: 3.288,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036) were also associated with malignancy risk, though not independently significant in Cox regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dynamic MPD monitoring is essential for assessing malignancy risk in patients with MPD\u2010involved IPMN. An MPD growth rate of \u2265\u20092\u2009mm\/year was the strongest predictor of malignant transformation, underscoring the value of longitudinal surveillance over static MPD diameter thresholds. Patients with rapid MPD growth should be considered for early surgical intervention or intensified monitoring to improve clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgh.70171","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T11:48:49Z","timestamp":1763725729000},"page":"341-351","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dynamic Predictors of Malignancy in Main Duct\u2010Involved IPMN: The Critical Role of MPD Diameter Changes in a Multicenter Study"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1969-516X","authenticated-orcid":false,"given":"Seong\u00a0Ji","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Korea University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae\u00a0Hyeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Biliopancreas, Department of Internal Medicine Wonkwang University College of Medicine  Iksan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae\u00a0Jun","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Ulsan College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung\u00a0Ku","family":"Chon","sequence":"additional","affiliation":[{"name":"Division of Biliopancreas, Department of Internal Medicine Wonkwang University College of Medicine  Iksan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun\u00a0Seong","family":"Hwang","sequence":"additional","affiliation":[{"name":"Center of Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hanyang University College of Medicine Changwon Hanmaeum Hospital  Changwon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5039-8182","authenticated-orcid":false,"given":"Min\u00a0Jae","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Ajou University School of Medicine  Suwon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8792-6249","authenticated-orcid":false,"given":"Jun\u2010Ho","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Dankook University College of Medicine  Cheonan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki\u00a0Hyun","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine Konyang University  Daejeon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong\u2010Hun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Chonbuk National University Medical School  Jeonju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2174-9726","authenticated-orcid":false,"given":"Sang\u00a0Hyub","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Liver Research Institute Seoul National University Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang\u00a0Min","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Kyungpook National University Kyungpook National University Chilgok Hospital  Daegu Republic of 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