Outcomes in Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer Differ from PanIN-derived Pancreatic Cancer

Overview

Journal J Gastroenterol Hepatol

Specialty Gastroenterology

Date 2024 Aug 1

PMID 39086101

Authors

Joseph R Habib

Ingmar F Rompen

Ammar A Javed

Mahip Grewal

Benedict Kinny-Koster

Paul C M Andel

D Brock Hewitt

Greg D Sacks

Marc G Besselink

Hjalmar C van Santvoort

Lois A Daamen

Martin Loos

Jin He

Markus W Buchler

Christopher L Wolfgang

I Quintus Molenaar

Affiliations

Soon will be listed here.

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 43.1 months (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 94.1 months (P < 0.001) in colloid. Matched (n = 495), PanIN-derived and IPMN-derived PDAC had mOSs of 30.6 and 42.8 months (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.

Citing Articles

ASO Author Reflections: Resected Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: Early Recurrence and Patient-Tailored Management.

Habib J, Rompen I, Hidalgo Salinas C, Groot V, Javed A, Daamen L Ann Surg Oncol. 2025; 32(4):2868-2869.

PMID: 39853482 PMC: 11882720. DOI: 10.1245/s10434-024-16810-8.

ASO Author Reflections: Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: A Need to Evaluate for Specific Staging Systems.

Habib J, Rompen I, Javed A, Daamen L Ann Surg Oncol. 2024; 31(13):8758-8759.

PMID: 39256311 PMC: 11549164. DOI: 10.1245/s10434-024-16131-w.

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

Habib J, Rompen I, Javed A, Grewal M, Kinny-Koster B, Andel P J Gastroenterol Hepatol. 2024; 39(11):2360-2366.

PMID: 39086101 PMC: 11618288. DOI: 10.1111/jgh.16686.

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