Adjuvant Therapy in Invasive Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas: a Systematic Review

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2020 Jan 14

PMID 31930090

Citations 15

Authors

Linus Aronsson

Sofia Marinko

Daniel Ansari

Roland Andersson

Affiliations

Soon will be listed here.

Abstract

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a cystic tumor with a disease spectrum ranging from low-grade dysplasia to invasive carcinoma. The evidence for adjuvant treatment in invasive IPMN is limited and mostly derived from studies in conventional pancreatic ductal adenocarcinoma (PDAC). We performed a systematic review focusing on all clinical studies concerning the efficacy of adjuvant therapy in patients with invasive IPMN. We identified 8 retrospective cohort studies, using either adjuvant chemotherapy alone (n=1), adjuvant radiotherapy alone (n=1) or adjuvant chemotherapy in combination with radiation (n=6). Adjuvant therapy was associated with a survival benefit in 7 out of the 8 studies. Specific survival benefit was noted for patients with node-positive disease, higher TNM stage, positive resection margins, poor differentiation and tubular subtype. We conclude that adjuvant therapy may be beneficial in invasive IPMN, but current data suggest that it should be given selectively based on individual tumor characteristics. Further prospective, randomized studies are warranted.

Citing Articles

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References

. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018; 67(5):789-804. PMC: 5890653. DOI: 10.1136/gutjnl-2018-316027. View

Neoptolemos J, Stocken D, Bassi C, Ghaneh P, Cunningham D, Goldstein D . Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA. 2010; 304(10):1073-81. DOI: 10.1001/jama.2010.1275. View

Neoptolemos J, Palmer D, Ghaneh P, Psarelli E, Valle J, Halloran C . Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017; 389(10073):1011-1024. DOI: 10.1016/S0140-6736(16)32409-6. View

Neoptolemos J, Stocken D, Friess H, Bassi C, Dunn J, Hickey H . A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004; 350(12):1200-10. DOI: 10.1056/NEJMoa032295. View

Duconseil P, Perinel J, Autret A, Adham M, Sauvanet A, Chiche L . Resectable invasive IPMN versus sporadic pancreatic adenocarcinoma of the head of the pancreas: Should these two different diseases receive the same treatment? A matched comparison study of the French Surgical Association (AFC). Eur J Surg Oncol. 2017; 43(9):1704-1710. DOI: 10.1016/j.ejso.2017.06.011. View

Adsay N, Merati K, Basturk O, Iacobuzio-Donahue C, Levi E, Cheng J . Pathologically and biologically distinct types of epithelium in intraductal papillary mucinous neoplasms: delineation of an "intestinal" pathway of carcinogenesis in the pancreas. Am J Surg Pathol. 2004; 28(7):839-48. DOI: 10.1097/00000478-200407000-00001. View

Mino-Kenudson M, Fernandez-Del Castillo C, Baba Y, Valsangkar N, Liss A, Hsu M . Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut. 2011; 60(12):1712-20. PMC: 3806085. DOI: 10.1136/gut.2010.232272. View

Waters J, Schnelldorfer T, Aguilar-Saavedra J, Chen J, Yiannoutsos C, Lillemoe K . Survival after resection for invasive intraductal papillary mucinous neoplasm and for pancreatic adenocarcinoma: a multi-institutional comparison according to American Joint Committee on Cancer Stage. J Am Coll Surg. 2011; 213(2):275-83. DOI: 10.1016/j.jamcollsurg.2011.04.003. View

Adsay N, Merati K, Nassar H, Shia J, Sarkar F, Pierson C . Pathogenesis of colloid (pure mucinous) carcinoma of exocrine organs: Coupling of gel-forming mucin (MUC2) production with altered cell polarity and abnormal cell-stroma interaction may be the key factor in the morphogenesis and indolent behavior of.... Am J Surg Pathol. 2003; 27(5):571-8. DOI: 10.1097/00000478-200305000-00002. View

10.

Turrini O, Waters J, Schnelldorfer T, Lillemoe K, Yiannoutsos C, Farnell M . Invasive intraductal papillary mucinous neoplasm: predictors of survival and role of adjuvant therapy. HPB (Oxford). 2010; 12(7):447-55. PMC: 3030753. DOI: 10.1111/j.1477-2574.2010.00196.x. View

11.

Alexander B, Fernandez-Del Castillo C, Ryan D, Kachnic L, Hezel A, Niemierko A . Intraductal papillary mucinous adenocarcinoma of the pancreas: clinical outcomes, prognostic factors, and the role of adjuvant therapy. Gastrointest Cancer Res. 2012; 4(4):116-21. PMC: 3283102. View

12.

Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang J, Levy P, Ohtsuka T . Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017; 17(5):738-753. DOI: 10.1016/j.pan.2017.07.007. View

13.

Adsay V, Mino-Kenudson M, Furukawa T, Basturk O, Zamboni G, Marchegiani G . Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract: Recommendations of Verona Consensus Meeting. Ann Surg. 2015; 263(1):162-77. PMC: 4568174. DOI: 10.1097/SLA.0000000000001173. View

14.

Ban S, Naitoh Y, Mino-Kenudson M, Sakurai T, Kuroda M, Koyama I . Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: its histopathologic difference between 2 major types. Am J Surg Pathol. 2006; 30(12):1561-9. DOI: 10.1097/01.pas.0000213305.98187.d4. View

15.

Marchegiani G, Andrianello S, Borgo C, Secchettin E, Melisi D, Malleo G . Adjuvant chemotherapy is associated with improved postoperative survival in specific subtypes of invasive intraductal papillary mucinous neoplasms (IPMN) of the pancreas: it is time for randomized controlled data. HPB (Oxford). 2018; 21(5):596-603. DOI: 10.1016/j.hpb.2018.09.013. View

16.

Caponi S, Vasile E, Funel N, De Lio N, Campani D, Ginocchi L . Adjuvant chemotherapy seems beneficial for invasive intraductal papillary mucinous neoplasms. Eur J Surg Oncol. 2013; 39(4):396-403. DOI: 10.1016/j.ejso.2012.12.005. View

17.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4:1. PMC: 4320440. DOI: 10.1186/2046-4053-4-1. View

18.

Aronsson L, Andersson R, Ansari D . Intraductal papillary mucinous neoplasm of the pancreas - epidemiology, risk factors, diagnosis, and management. Scand J Gastroenterol. 2017; 52(8):803-815. DOI: 10.1080/00365521.2017.1318948. View

19.

Worni M, Akushevich I, Gloor B, Scarborough J, Chino J, Jacobs D . Adjuvant radiotherapy in the treatment of invasive intraductal papillary mucinous neoplasm of the pancreas: an analysis of the surveillance, epidemiology, and end results registry. Ann Surg Oncol. 2011; 19(4):1316-23. DOI: 10.1245/s10434-011-2088-2. View

20.

Russ A, Weber S, Rettammel R, Mahvi D, Rikkers L, Cho C . Impact of selection bias on the utilization of adjuvant therapy for pancreas adenocarcinoma. Ann Surg Oncol. 2009; 17(2):371-6. PMC: 4859782. DOI: 10.1245/s10434-009-0759-z. View