浸润性导管内乳头状黏液性肿瘤与原发性胰腺导管腺癌手术切除后的肿瘤学结局及复发模式：来自德国肿瘤中心协会德国癌症登记组的分析
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.
作者信息
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
机构信息
Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany.
Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany.
出版信息
Cancers (Basel). 2024 May 26;16(11):2016. doi: 10.3390/cancers16112016.
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 ( = 217) as well as PDAC ( = 5794) between 2000 and 2021 were included and compared regarding oncological outcomes.
RESULTS
Invasive IPMN was significantly smaller in size ( < 0.001) and of a lower tumor grade ( < 0.001), with fewer lymph node metastases ( < 0.001), lymphangiosis ( < 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.
背景
导管内乳头状黏液性肿瘤（IPMNs）是胰腺的癌前囊性肿瘤（CNPs），可进展为浸润性IPMN和胰腺癌。现有文献对于浸润性IPMN切除术后的预后和临床结局显示出有争议的结果。
目的
本研究旨在描述非转移性浸润性IPMN切除术后的肿瘤学结局和转移进展模式。
方法
数据来自参与德国肿瘤中心协会（ADT）德国癌症登记组的24个临床癌症登记处。纳入2000年至2021年间的浸润性IPMN患者（n = 217）以及胰腺导管腺癌（PDAC）患者（n = 5794），并比较其肿瘤学结局。
结果
与PDAC相比，浸润性IPMN的肿瘤大小显著更小（P < 0.001），肿瘤分级更低（P < 0.001），淋巴结转移更少（P < 0.001），淋巴管浸润更少（P < 0.001），因此R0切除率更高（88%对74%）。此外，浸润性IPMN的局部复发（11%对15%）和远处复发更少（29%对46%），且仅肺转移更为常见（26%对14%）。与PDAC相比，浸润性IPMN的中位总生存期（OS）更长（29个月对19个月），无病生存期（DFS）更长（31个月对15个月），并且在多变量分析中保持独立的预后意义。这些生存差异在肿瘤早期最为明显。有趣的是，术后化疗与手术切除的浸润性IPMN患者的总生存期改善无关。
结论
浸润性IPMN是德国一种发病率不断上升的罕见胰腺疾病。与PDAC相比，它在切除时具有良好的组织病理学特征，OS和DFS更长，尤其是在局部区域扩散发生之前。浸润性IPMN与仅肺转移相关。浸润性IPMN切除术后术后化疗的益处仍不确定。
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