Munseok Choi1, Jae Uk Chong2, Ho Kyoung Hwang3, Hyung-Il Seo4, Kwangho Yang5, Je Ho Ryu5, Younghoon Roh6, Dong Hyun Kim7, Jin Ho Lee2, Woo Jung Lee3, Sung Hoon Choi8, Chang Moo Kang3. 1. Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Korea. 2. Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea. 3. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 4. Biomedical research institute, Pusan National University Hospital, Busan, Korea. 5. Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea. 6. Department of Surgery, Dong-A University Medical center, Dong-A University College of Medicine, Busan, Korea. 7. Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea. 8. Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongam-si, Korea.
Abstract
BACKGROUND: Adjuvant therapy is beneficial in prolonging survival in patients with pancreatic ductal adenocarcinoma (PDAC). However, no clear guidelines are available on the oncologic effect of adjuvant therapy in resected invasive intraductal papillary mucinous neoplasms (inv-IPMN). METHODS: In total, 551 patients with PDAC and 67 patients with inv-IPMN of the pancreas were reviewed. For external validation, 46 patients with inv-IPMN from six other Korean institutions were enrolled. Propensity score-matched analysis and stage-matched survival analysis were conducted. RESULTS: The mean follow-up durations in the inv-IPMN and PDAC groups were 43.36 months (SD, 42.34 months) and 43.35 months (SD, 35.62 months), respectively. The 5-year overall survival (OS) was significantly better in the resected inv-IPMN group than in the PDAC group in the overall stage-matched analysis (p<0.001). In the inv-IPMN cohort, OS was better in the surgery alone group (p=0.042). In subgroup analysis, no significant survival difference was found between the adjuvant therapy and surgery alone groups according to the stage (stage I; p=0.285, stage II or III; p=0.077). Multicenter external validation did not show a better OS in the adjuvant therapy group (p=0.531). On multivariable analysis, only perineural invasion (PNI) was identified as an adverse prognostic factor in resected inv-IPMN (HR 4.844; 95% CI 1.696-13.838, p=0.003). CONCLUSIONS: inv-IPMN has a more indolent course than PDAC. Current strategy of adjuvant therapy may not improve the OS in patients with resected inv-IPMN. Further investigations on the potential role of adjuvant therapy in inv-IPMN are mandatory. This article is protected by copyright. All rights reserved.
BACKGROUND: Adjuvant therapy is beneficial in prolonging survival in patients with pancreatic ductal adenocarcinoma (PDAC). However, no clear guidelines are available on the oncologic effect of adjuvant therapy in resected invasive intraductal papillary mucinous neoplasms (inv-IPMN). METHODS: In total, 551 patients with PDAC and 67 patients with inv-IPMN of the pancreas were reviewed. For external validation, 46 patients with inv-IPMN from six other Korean institutions were enrolled. Propensity score-matched analysis and stage-matched survival analysis were conducted. RESULTS: The mean follow-up durations in the inv-IPMN and PDAC groups were 43.36 months (SD, 42.34 months) and 43.35 months (SD, 35.62 months), respectively. The 5-year overall survival (OS) was significantly better in the resected inv-IPMN group than in the PDAC group in the overall stage-matched analysis (p<0.001). In the inv-IPMN cohort, OS was better in the surgery alone group (p=0.042). In subgroup analysis, no significant survival difference was found between the adjuvant therapy and surgery alone groups according to the stage (stage I; p=0.285, stage II or III; p=0.077). Multicenter external validation did not show a better OS in the adjuvant therapy group (p=0.531). On multivariable analysis, only perineural invasion (PNI) was identified as an adverse prognostic factor in resected inv-IPMN (HR 4.844; 95% CI 1.696-13.838, p=0.003). CONCLUSIONS: inv-IPMN has a more indolent course than PDAC. Current strategy of adjuvant therapy may not improve the OS in patients with resected inv-IPMN. Further investigations on the potential role of adjuvant therapy in inv-IPMN are mandatory. This article is protected by copyright. All rights reserved.
Authors: Myrte Gorris; Nadine C M van Huijgevoort; Arantza Farina; Lodewijk A A Brosens; Hjalmar C van Santvoort; Bas Groot Koerkamp; Marco J Bruno; Marc G Besselink; Jeanin E van Hooft Journal: Cancers (Basel) Date: 2022-08-30 Impact factor: 6.575