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- Title
Oncological Outcomes and Patterns of Recurrence after the Surgical Resection of an Invasive Intraductal Papillary Mucinous Neoplasm versus Primary Pancreatic Ductal Adenocarcinoma: An Analysis from the German Cancer Registry Group of the Society of German Tumor Centers
- Authors
Abdalla, Thaer S. A.; Duhn, Jannis; Klinkhammer-Schalke, Monika; Zeissig, Sylke Ruth; Kleihues-van Tol, Kees; Honselmann, Kim C.; Braun, Rüdiger; Kist, Markus; Bolm, Louisa; von Fritsch, Lennart; Lapshyn, Hryhoriy; Litkevych, Stanislav; Hummel, Richard; Zemskov, Sergii; Wellner, Ulrich Friedrich; Keck, Tobias; Deichmann, Steffen
- Abstract
Simple Summary: This retrospective study, based on data from the German Cancer Registry Group of the Society of German Tumor Centers, analyzed a specific type of malignant cystic pancreatic neoplasm, called invasive IPMN, and compared it to pancreatic ductal adenocarcinoma (PDAC). Invasive IPMN tumors were of smaller size and less aggressive, and their complete removal during surgery was achieved more frequently. Patients with invasive IPMN generally had better outcomes after surgery, with longer survival times and fewer recurrences, especially in the early stages of the disease. Interestingly, chemotherapy after surgery did not result in a survival benefit in patients with invasive IPMN. Overall, this retrospective study suggests that invasive IPMN represents a less aggressive type of pancreatic cancer resulting in a favorable prognosis, especially in early tumor stages, thus highlighting the relevance of the already existing surveillance programs of this entity. Background: Intraductal papillary mucinous neoplasms (IPMNs) are premalignant cystic neoplasms of the pancreas (CNPs), which can progress to invasive IPMN and pancreatic cancer. The available literature has shown controversial results regarding prognosis and clinical outcomes after the resection of invasive IPMN. Aims: This study aims to characterize the oncologic outcomes and metastatic progression pattern after the resection of non-metastatic invasive IPMN. Methods: Data were obtained from 24 clinical cancer registries participating in the German Cancer Registry Group of the Society of German Tumor Centers (ADT). Patients with invasive IPMN (n = 217) as well as PDAC (n = 5794) between 2000 and 2021 were included and compared regarding oncological outcomes. Results: Invasive IPMN was significantly smaller in size (p < 0.001) and of a lower tumor grade (p < 0.001), with fewer lymph node metastases (p < 0.001), lymphangiosis (p < 0.001), and consequently a higher R0 resection rate (88 vs. 74%) compared to PDAC. Moreover, invasive IPMN was associated with fewer local (11 vs. 15%) and distant recurrences (29 vs. 46%) and metastasized more frequently in the lungs only (26% vs. 14%). Invasive IPMN was associated with a longer median OS (29 vs. 19 months) and DFS (31 vs. 15 months) compared to PDAC and stayed independently prognostic in multivariable analyses. These survival differences were most pronounced in early tumor stages. Interestingly, postoperative chemotherapy was not associated with improved overall survival in surgically resected invasive IPMN. Conclusions: Invasive IPMN is a rare pancreatic entity with increasing incidence in Germany. It is associated with favorable histopathological features at the time of resection and longer OS and DFS compared to PDAC, particularly before the locoregional spread has occurred. Invasive IPMNs are associated with lung-only metastasis. The benefit of postoperative chemotherapy after the resection of invasive IPMN remains uncertain.
- Subjects
GERMANY; TUMOR surgery; ADENOCARCINOMA; LYMPH nodes; CANCER invasiveness; CANCER relapse; PAPILLARY carcinoma; TREATMENT effectiveness; RETROSPECTIVE studies; CANCER patients; TUMOR grading; PANCREATIC tumors; METASTASIS; DUCTAL carcinoma; MEDICAL records; ACQUISITION of data; TUMOR classification; EVALUATION
- Publication
Cancers, 2024, Vol 16, Issue 11, p2016
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16112016