Re-evaluating routinely collected clinical and laboratory parameters in the preoperative risk assessment of intraductal papillary mucinous neoplasms: model development and internal validation

IF 3.9 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2026-05-01 Epub Date: 2026-03-06 DOI:10.1016/j.pan.2026.03.003

Camila Hidalgo Salinas , Mahip Grewal , Vishnu Jayaprakash , Joseph R. Habib , D Brock Hewitt , Brian J. Kaplan , Katherine A. Morgan , Tamas A. Gonda , Christopher L. Wolfgang , Rafael Perera , Greg D. Sacks , Ammar A. Javed

{"title":"Re-evaluating routinely collected clinical and laboratory parameters in the preoperative risk assessment of intraductal papillary mucinous neoplasms: model development and internal validation","authors":"Camila Hidalgo Salinas , Mahip Grewal , Vishnu Jayaprakash , Joseph R. Habib , D Brock Hewitt , Brian J. Kaplan , Katherine A. Morgan , Tamas A. Gonda , Christopher L. Wolfgang , Rafael Perera , Greg D. Sacks , Ammar A. Javed","doi":"10.1016/j.pan.2026.03.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Accurate preoperative malignancy risk assessment in intraductal papillary mucinous neoplasm (IPMN) is essential to balance timely intervention for high-grade dysplasia or invasive cancer (HGD/IC) against avoiding unnecessary or premature surgery in low-grade IPMN. This study aimed to externally validate the 2023 International Association of Pancreatology (IAP)/Kyoto guidelines and develop a combined prediction model incorporating routinely collected clinical data and laboratory parameters.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 194 patients who underwent resection for IPMN between 2012 and 2024. We evaluated the predictive performance of the current IAP/Kyoto criteria (“Kyoto model”), developed a clinical model using routinely available laboratory and clinical variables, and integrated both into a combined model. Model performance was assessed using discrimination and calibration metrics, with internal validation via bootstrapping and five-fold cross-validation.</div></div><div><h3>Results</h3><div>The Kyoto model demonstrated modest discrimination (AUC 0.62). The clinical model, incorporating neutrophil-to-lymphocyte ratio (NLR), smoking history, blood glucose, CA19-9, and alkaline phosphatase, achieved an optimism-corrected AUC of 0.76. Compared to the Kyoto model, the combined model (AUC 0.77) significantly improved discrimination and calibration (p < 0.001). At a predicted probability threshold of >0.75, the combined model achieved a 90% specificity and 91% positive predictive value for HGD/IC, identifying a high-risk subgroup suitable for surgical intervention.</div></div><div><h3>Conclusions</h3><div>Integrating routinely collected clinical and laboratory parameters with guideline-based imaging features shows promise to enhance preoperative identification of high-risk IPMN in patients already being considered for surgical resection. The combined model offers a practical, high-specificity tool to support surgical decision-making in this selected population, though its performance metrics should not be extrapolated to unselected surveillance cohorts. External validation is required before broader clinical implementation.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"26 3","pages":"Pages 436-443"},"PeriodicalIF":3.9000,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pancreatology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1424390326001237","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/3/6 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Accurate preoperative malignancy risk assessment in intraductal papillary mucinous neoplasm (IPMN) is essential to balance timely intervention for high-grade dysplasia or invasive cancer (HGD/IC) against avoiding unnecessary or premature surgery in low-grade IPMN. This study aimed to externally validate the 2023 International Association of Pancreatology (IAP)/Kyoto guidelines and develop a combined prediction model incorporating routinely collected clinical data and laboratory parameters.

Methods

We conducted a retrospective cohort study of 194 patients who underwent resection for IPMN between 2012 and 2024. We evaluated the predictive performance of the current IAP/Kyoto criteria (“Kyoto model”), developed a clinical model using routinely available laboratory and clinical variables, and integrated both into a combined model. Model performance was assessed using discrimination and calibration metrics, with internal validation via bootstrapping and five-fold cross-validation.

Results

The Kyoto model demonstrated modest discrimination (AUC 0.62). The clinical model, incorporating neutrophil-to-lymphocyte ratio (NLR), smoking history, blood glucose, CA19-9, and alkaline phosphatase, achieved an optimism-corrected AUC of 0.76. Compared to the Kyoto model, the combined model (AUC 0.77) significantly improved discrimination and calibration (p < 0.001). At a predicted probability threshold of >0.75, the combined model achieved a 90% specificity and 91% positive predictive value for HGD/IC, identifying a high-risk subgroup suitable for surgical intervention.

Conclusions

Integrating routinely collected clinical and laboratory parameters with guideline-based imaging features shows promise to enhance preoperative identification of high-risk IPMN in patients already being considered for surgical resection. The combined model offers a practical, high-specificity tool to support surgical decision-making in this selected population, though its performance metrics should not be extrapolated to unselected surveillance cohorts. External validation is required before broader clinical implementation.

查看原文本刊更多论文

重新评估导管内乳头状粘液瘤术前风险评估中常规收集的临床和实验室参数：模型开发和内部验证。

背景：导管内乳头状粘液瘤（IPMN）术前准确的恶性风险评估对于及时干预高级别发育不良或浸润性癌（HGD/IC）与避免低级别IPMN不必要或过早手术至关重要。本研究旨在外部验证2023年国际胰脏学协会(IAP)/京都指南，并开发一个结合常规收集的临床数据和实验室参数的联合预测模型。方法：我们对2012年至2024年间接受IPMN切除术的194例患者进行了回顾性队列研究。我们评估了当前IAP/京都标准（“京都模型”）的预测性能，利用常规可用的实验室和临床变量开发了一个临床模型，并将两者整合到一个组合模型中。使用判别和校准指标评估模型性能，并通过自助和五倍交叉验证进行内部验证。结果：京都模型具有适度判别（AUC 0.62）。纳入中性粒细胞与淋巴细胞比率（NLR）、吸烟史、血糖、CA19-9和碱性磷酸酶的临床模型获得了乐观校正的AUC为0.76。与京都模型相比，联合模型（AUC 0.77）显著改善了识别和校准（p < 0.001）。在预测概率阈值为>0.75时，联合模型对HGD/IC的特异性达到90%，阳性预测值为91%，确定了适合手术干预的高危亚群。结论：将常规收集的临床和实验室参数与基于指南的影像学特征相结合，有望加强对已经考虑手术切除的高危IPMN患者的术前识别。该联合模型提供了一种实用的、高特异性的工具来支持选定人群的手术决策，尽管其性能指标不应外推到未选定的监测队列。在更广泛的临床应用之前，需要外部验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.