Abstract
Background/objectivesResections for intraductal papillary mucinous neoplasm (IPMN) have increased last decades. Overall survival (OS) for conventional pancreatic ductal adenocarcinoma (PDAC) is well known but OS for invasive IPMN (inv-IPMN) is not as conclusive. This study aims to elucidate potential differences in clinicopathology and OS between these tumor types and to investigate if the raised number of resections have affected outcome. MethodsConsecutive patients ≥18 years of age resected for inv-IPMN and PDAC at Karolinska University Hospital between 2009 and 2018 were included. Clinicopathological variables were analyzed in multivariable regression models. Outcome was assessed calculating two-year OS, estimating OS using the Kaplan-Meier model and comparing survival functions with log-rank test. Results513 patients were included, 122 with inv-IPMN and 391 with PDAC. During the study period both the proportion resected inv-IPMN and two-year OS, irrespective of tumor type, increased (2.5%–45%; p < 0.001 and 44%–57%; p = 0.005 respectively). In Kaplan-Meier survival analysis inv-IPMN had more favorable median OS (mOS) compared to PDAC (33.6 months vs 19.3 months, p = 0.001). However, in multivariable Cox Regression analysis, tumor type was not a predictor for death, but so were resection period, tumor subtype and N-stage (all p < 0.001). ConclusionIn this large single center observational cohort study, inv-IPMN seemed to have favorable survival outcome compared to PDAC, but after adjusting for predictors for death this benefit vanished. The combination of a pronounced increase in resected inv-IPMN and a concurrent hazard abatement for death within 2 years during the study period proved to be a principal factor.
Highlights
Intraductal papillary mucinous neoplasm (IPMN) is a cystic neoplasm in the pancreas characterized by duct dilatation, mucin over-production and a potential malignant transformation to pancreatic ductal adenocarcinoma PDAC [1], a malevolent cancer with a five-year Overall survival (OS) of 15e20% following resection and adjuvant chemotherapy [2]
This study aims to elucidate potential differences in clinicopathology and OS between patients resected for inv-IPMN and PDAC, and to investigate whether the increased numbers of pancreatic resections for inv-IPMN in combination with the amelioration in survival the last years have affected outcome
This study suggests that outcome for resected inv-IPMN is similar to PDAC after adjusting for predictors for death, such as operating period, tumor subtype and tumor stage
Summary
Intraductal papillary mucinous neoplasm (IPMN) is a cystic neoplasm in the pancreas characterized by duct dilatation, mucin over-production and a potential malignant transformation to pancreatic ductal adenocarcinoma PDAC [1], a malevolent cancer with a five-year OS of 15e20% following resection and adjuvant chemotherapy [2]. IPMN is one of three known precursors for PDAC and accounts for 10e15% of all PDAC [3]. Recent findings suggest that the pancreatobiliary and intestinal subtypes progress to an invasive form [7,8]. The predominant pancreatobiliary subtype can give rise to the tubular cancer with properties similar to conventional PDAC, and the indolent intestinal subtype can develop into the colloid cancer with more favorable outcome [9,10]. The scarce and ominous adenosquamous subtype is primarily encountered in PDAC and rarely mentioned in this context but has been reported for inv-IPMN [11]. The oncocytic variant with a reported mOS of 132 months [12] is no longer considered an inv-IPMN according to the 2019 WHO
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