Outcomes in intraductal papillary mucinous neoplasm-derived pancreatic cancer differ from PanIN-derived pancreatic cancer. (2024)

Afiliación

• Habib JR; Department of Surgery, New York University Langone Health, New York, New York, USA.
• Rompen IF; Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
• Javed AA; Department of Surgery, New York University Langone Health, New York, New York, USA.
• Grewal M; Heidelberg University Hospital, Heidelberg, Germany.
• Kinny-Köster B; Department of Surgery, New York University Langone Health, New York, New York, USA.
• Andel PCM; Department of Surgery, New York University Langone Health, New York, New York, USA.
• Hewitt DB; Heidelberg University Hospital, Heidelberg, Germany.
• Sacks GD; Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
• Besselink MG; Department of Surgery, New York University Langone Health, New York, New York, USA.
• van Santvoort HC; Department of Surgery, New York University Langone Health, New York, New York, USA.
• Daamen LA; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.
• Loos M; Cancer Center Amsterdam, Amsterdam, The Netherlands.
• He J; Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
• Büchler MW; Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
• Wolfgang CL; Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
• Molenaar IQ; Heidelberg University Hospital, Heidelberg, Germany.

ABSTRACT

BACKGROUND AND

AIM:

Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) management is generally extrapolated from pancreatic intraepithelial neoplasia (PanIN)-derived PDAC guidelines. However, these are biologically divergent, and heterogeneity further exists between tubular and colloid subtypes.

METHODS:

Consecutive upfront surgery patients with PanIN-derived and IPMN-derived PDAC were retrospectively identified from international centers (2000-2019). One-to-one propensity score matching for clinicopathologic factors generated three cohorts IPMN-derived versus PanIN-derived PDAC, tubular IPMN-derived versus PanIN-derived PDAC, and tubular versus colloid IPMN-derived PDAC. Overall survival (OS) was compared using Kaplan-Meier and log-rank tests. Multivariable Cox regression determined corresponding hazard ratios (HR) and 95% confidence intervals (95% CI).

RESULTS:

The median OS (mOS) in 2350 PanIN-derived and 700 IPMN-derived PDAC patients was 23.0 and 43.1months (P<0.001), respectively. PanIN-derived PDAC had worse T-stage, CA19-9, grade, and nodal status. Tubular subtype had worse T-stage, CA19-9, grade, nodal status, and R1 margins, with a mOS of 33.7 versus 94.1months (P<0.001) in colloid. Matched (n=495), PanIN-derived and IPMN-derived PDAC had mOSs of 30.6 and 42.8months (P<0.001), respectively. In matched (n=341) PanIN-derived and tubular IPMN-derived PDAC, mOS remained poorer (27.7 vs 37.4, P<0.001). Matched tubular and colloid cancers (n=112) had similar OS (P=0.55). On multivariable Cox regression, PanIN-derived PDAC was associated with worse OS than IPMN-derived (HR 1.66, 95% CI 1.44-1.90) and tubular IPMN-derived (HR 1.53, 95% CI 1.32-1.77) PDAC. Colloid and tubular subtype was not associated with OS (P=0.16).

CONCLUSIONS:

PanIN-derived PDAC has worse survival than IPMN-derived PDAC supporting distinct outcomes. Although more indolent, colloid IPMN-derived PDAC has similar survival to tubular after risk adjustment.