Invasive IPMN relapse later and more often in lungs in comparison to pancreatic ductal adenocarcinoma |
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| Institution: | 1. Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy;2. Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy;3. Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy;4. Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy;5. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy;1. Division of Pediatric Gastroenterology and Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;2. Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;3. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India;4. Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India;1. Indiana University School of Medicine, United States;2. Charles Warren Fairbanks Center of Medical Ethics, Indiana University Health, United States;3. Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, United States;1. Division of Gastroenterology, Hepatology, and Nutrition. the Ohio State University Wexner Medical Center, Columbus, OH, USA;2. Department of Internal Medicine. University of Kentucky College of Medicine, Lexington, KY, USA;3. Division of Pulmonary, Critical Care, and Sleep Medicine. the Ohio State University Wexner Medical Center, Columbus, OH, USA;4. Division of Epidemiology. the Ohio State University College of Public Health, Columbus, OH, USA;5. Cedars Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, CA, USA;6. Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;1. Wellcome-DBT India Alliance Labs., Institute of Basic and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India;2. Department of Radiodiagnosis, Asian Institute of Gastroenterology, Hyderabad, India;3. Ceders-Sinai Medical Center, Los Angeles, United States;4. Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India;5. Division of Clinical Research, Asian Institute of Gastroenterology, Hyderabad, India;6. Division of Psychiatry, Asian Institute of Gastroenterology, Hyderabad, India;1. Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;2. Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA |
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| Abstract: | BackgroundThe different oncological outcomes of invasive intraductal papillary mucinous neoplasm (I-IPMN) and pancreatic ductal adenocarcinoma (PDAC) are debated. This study aimed to compare disease recurrence patterns and histopathological characteristics in patients with resected I-IPMN and PDAC.MethodsConsecutive patients undergoing surgical resection for stage I-III I-IPMN or PDAC between 2010 and 2016 were retrospectively analyzed. Patients treated with neoadjuvant therapy or resected for Tis neoplasia were excluded. All surgical specimens were re-staged according to AJCC-8th-edition.ResultsA total of 330 patients were included, of whom 43 had I-IPMN and 287 had PDAC. Median follow-up time was 26.7 (1.3–92.3) months and estimated median disease-free survival (DFS) was 60.3 months (47.2–73.4) for I-IPMN and 23.8 (19.3–28.2) months for PDAC (p < 0.001). During follow-up, 32.6% of I-IPMN and 67.9% of PDAC patients experienced recurrence (p < 0.001). The sites of first recurrence were the lungs (38.5% vs 13.1%, p = 0.027), liver (28.6% vs 45.0%, p = 0.180) and local (15.4% vs 36.6%, p = 0.101) for I-IPMN and PDAC, respectively. At multivariate analysis, I-IPMN histology remained an independent predictive factor for longer DFS (OR 0.528, CI 95% 0.278–1.000, p = 0.050), regardless of stage or adjuvant chemotherapy. I-IPMN and PDAC differed in rates of neuroinvasion (51.2% vs 97.2%) and positive lymph node status (N+) (46.5% vs 82.7%), especially in patients with lower T status.ConclusionI-IPMN showed a different recurrence pattern compared to PDAC, with a higher lung tropism, and longer DFS. This different biological behavior is associated with lower rates of neuroinvasion and nodal involvement, especially in early-stage disease. |
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| Keywords: | Invasive intraductal papillary mucinous neoplasm Pancreatic ductal adenocarcinoma Recurrence pattern |
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