Purpose: This study aims to investigate clinicopathologic characteristics, progression, and prognosis of intraductal papillary neoplasm of the bile duct (IPNB) through a multicenter cohort study. Materials and methods: We conducted a retrospective analysis of clinical data and postoperative follow-up of IPNB patients from eight medical institutions. Clinical features were compared among different histological types and anatomical locations, and then prognosis and risk factors were analyzed. Results: 118 patients (median age 62 years; 56.8% male) were included, 79 (66.9%) had malignant and 39 (33.1%) had benign lesions. IPNB was categorized into intrahepatic, extrahepatic, and diffuse types based on anatomical locations, with 57 (48.3%), 53 (44.9%), and 8 (6.8%) patients in each group, respectively. Male, history of choledocholithiasis, jaundice, and elevated CA 19-9 were associated with malignancy ( P < 0.05). The median largest tumor size (LTS) was 2.5 (2.0–4.0) cm, with 22 (18.6%) multifocal lesions. Multivariate logistic regression analysis indicated that a history of choledocholithiasis is an independent influencing factor against malignancy (OR 0.37, 95% CI 0.14–0.97; P = 0.043). Among malignant cases, the 1-, 2-, and 3-year survival rates were 71.9%, 58.9%, and 48.5%, respectively, with a median survival time of 33 months. The diffuse type had a median survival of only 6 months, and multivariable Cox regression analysis identified anatomical type (diffuse vs. intrahepatic: HR 7.41, 95% CI 1.71–32.14; P = 0.007), LTS (HR 1.20 per cm, 95% CI 1.05–1.37; P = 0.006), and surgery (open surgery vs. none: HR 0.17, 95% CI 0.04–0.68; P = 0.012) as independent prognostic factors. Conclusion: IPNB is frequently diagnosed at an invasive stage, with poor preoperative recognition. This study enhances the understanding of IPNB and may guide clinical management. In particular, diffuse lesions are associated with poor prognosis and urgently require clinical guidance.
Zhao et al. (Tue,) studied this question.