Rift Charlotte Vestrup, Lund Eva Løbner, Scheie David, Hansen Carsten Palnæs, Hasselby Jane Preuss
Department of Pathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Department of Pathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Hum Pathol. 2021 Jul;113:47-58. doi: 10.1016/j.humpath.2021.04.009. Epub 2021 Apr 26.
Invasive intraductal papillary mucinous neoplasms (inv-IPMNs) have a better prognosis than regular pancreatic ductal adenocarcinoma (PDAC), but no association with status of surgical margins and microscopic infiltration patterns has previously been described. The aim of this study is to review patterns of invasion and the predictive value of clinical guidelines in terms of rates of resection of high-grade dysplasia (HGD) and cancer among intraductal papillary mucinous neoplasms (IPMNs). Consecutively, resected IPMNs between 2011 and 2017 were analyzed. Data were obtained from a prospectively maintained database. A total of 132 patients were identified. Out of these, 38 patients with inv-IPMNs, initially identified as solid lesions suspicious of cancer, were compared with a control group of 101 patients with ordinary PDAC. Lower rates of vascular invasion, perineural invasion, lymph node metastasis, advanced T stage, and R1 status were characteristic of the inv-IPMNs in addition to better overall survival (OS) for a low tumor stage. Furthermore, as novel findings, the PDACs presented with resection margin involvement of 3 or more positive margins (31.3% vs. 9.5%, p = 0.044), associated with poor OS. Of the patients presenting as pT3, the inv-IPMN less often invaded more than one extrapancreatic anatomical structure (40.1% vs. 63.9%, p = 0.03). Regarding the predictive value of clinical guidelines, the frequency of resected HGD in IPMNs with high-risk stigmata (n = 54) and IPMNs with worrisome features was 30.7%, and the frequency of invasive carcinoma was 5.7%. In conclusion, we report a low resection rate of high-risk IPMNs and present novel findings describing inv-IPMNs as a less infiltrative phenotype compared with regular PDAC.
浸润性导管内乳头状黏液性肿瘤（inv-IPMNs）的预后优于普通胰腺导管腺癌（PDAC），但此前尚未描述其与手术切缘状态及微观浸润模式之间的关联。本研究旨在回顾导管内乳头状黏液性肿瘤（IPMNs）的浸润模式以及临床指南对高级别异型增生（HGD）和癌症切除率的预测价值。连续分析了2011年至2017年间接受手术切除的IPMNs。数据来自前瞻性维护的数据库。共识别出132例患者。其中，38例最初被识别为疑似癌症的实性病变的inv-IPMNs患者与101例普通PDAC患者的对照组进行了比较。除低肿瘤分期患者总体生存率（OS）更好外，inv-IPMNs的血管侵犯、神经周围侵犯、淋巴结转移、晚期T分期和R1状态发生率较低。此外，作为新发现，PDAC出现3个或更多阳性切缘的切缘受累情况（31.3%对9.5%，p = 0.044），与较差的OS相关。在表现为pT3的患者中，inv-IPMN较少侵犯超过一个胰腺外解剖结构（40.1%对63.9%，p = 0.03）。关于临床指南的预测价值，具有高危特征的IPMNs（n = 54）和具有可疑特征的IPMNs中切除的HGD频率为30.7%，浸润性癌的频率为5.7%。总之，我们报告了高危IPMNs的低切除率，并呈现了新的发现，即与普通PDAC相比，inv-IPMNs是一种浸润性较小的表型。
