Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Gastrointest Surg. 2022 Nov;26(11):2311-2320. doi: 10.1007/s11605-022-05428-4. Epub 2022 Aug 1.
To identify predictors, patterns, and timing of recurrence after resection of invasive carcinomas arising in association with an IPMN.
Postoperative management of an invasive carcinoma arising in association with an intraductal papillary mucinous neoplasm (IPMN), a biologically distinct entity from PanIN-derived pancreatic ductal adenocarcinoma (PDAC), remains largely based on guidelines for PanIN-derived PDAC. To minimize treatment failure and inform disease-specific management, cancer recurrence must be better characterized.
Patients were identified from a prospectively maintained registry between 1996 and 2018. Predictors of recurrence were evaluated by employing Cox regression models to determine risk-adjusted hazard ratios (HR) with 95% confidence intervals (95%CI). The patterns and timing of recurrence were recognized and compared utilizing a log-rank test, respectively.
Of the 213 patients included, 92 (43.2%) recurred with a median RFS of 23.7 months (16.7-30.7). The predominant pattern of recurrence included any systemic (65.2%). The median time to local recurrence was longer than systemic (21.6 versus 11.4 months, p = 0.05). Poor differentiation [HR: 3.01, 95%CI (1.06-8.61)] and nodal disease [N1, HR: 2.23, 95%CI (1.12-4.60); and N2, HR: 5.67 95%CI (2.93-10.99)] emerged as independent predictors of systemic recurrence. For local-specific recurrences, poor differentiation [HR: 3.73, 95%CI (1.04-13.45)] and an R1 margin [high-grade dysplasia or invasive carcinoma; HR: 2.66, 95%CI (1.14-6.21)] emerged as independent predictors.
The predominant pattern of recurrence after resection of invasive carcinomas arising in association with IPMNs is systemic, and occurs earlier than local recurrence. Poor differentiation and nodal disease are associated with systemic recurrence while poor differentiation and an R1 margin are associated with local recurrence. Future studies should investigate the role of systemic (chemotherapy) versus local (radiation) therapies and surveillance strategies in a personalized manner.
确定与 IPMN 相关的浸润性癌切除后复发的预测因素、模式和时间。
与导管内乳头状黏液性肿瘤 (IPMN) 相关的浸润性癌（一种与 PanIN 衍生的胰腺导管腺癌 (PDAC) 在生物学上不同的实体）术后管理在很大程度上仍基于 PanIN 衍生 PDAC 的指南。为了最大限度地减少治疗失败并为特定疾病的管理提供信息，必须更好地描述癌症复发。
本研究从 1996 年至 2018 年期间的前瞻性维护登记处中确定了患者。通过使用 Cox 回归模型评估复发的预测因素，以确定风险调整后的危险比 (HR) 和 95%置信区间 (95%CI)。分别使用对数秩检验识别和比较复发的模式和时间。
在 213 名患者中，92 名 (43.2%) 复发，中位 RFS 为 23.7 个月（16.7-30.7）。复发的主要模式包括任何全身（65.2%）。局部复发的中位时间长于全身（21.6 与 11.4 个月，p=0.05）。低分化 [HR:3.01,95%CI(1.06-8.61)] 和淋巴结疾病 [N1，HR:2.23,95%CI(1.12-4.60);和 N2，HR:5.67 95%CI(2.93-10.99)] 是全身复发的独立预测因素。对于局部复发，低分化 [HR:3.73,95%CI(1.04-13.45)] 和 R1 切缘 [高级别异型增生或浸润性癌；HR:2.66,95%CI(1.14-6.21)] 是独立预测因素。
与 IPMN 相关的浸润性癌切除后复发的主要模式是全身性的，且早于局部复发。低分化和淋巴结疾病与全身复发有关，而低分化和 R1 切缘与局部复发有关。未来的研究应探讨全身性（化疗）与局部（放疗）治疗以及个体化监测策略的作用。
