从导管内乳头状黏液性肿瘤（A-IPMN）发生的腺癌前上皮亚型：临床病理特征、复发和辅助化疗反应。

Precursor Epithelial Subtypes of Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasms (A-IPMN): Clinicopathological Features, Recurrence and Response to Adjuvant Chemotherapy.

机构信息

Department of General Surgery, NHS Lothian, Edinburgh, UK.

Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK.

出版信息

Ann Surg Oncol. 2024 Oct;31(10):7023-7032. doi: 10.1245/s10434-024-15677-z. Epub 2024 Jul 3.

DOI:10.1245/s10434-024-15677-z

PMID:38961040

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11413116/

Abstract

BACKGROUND

The clinico-oncological outcomes of precursor epithelial subtypes of adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) are limited to small cohort studies. Differences in recurrence patterns and response to adjuvant chemotherapy between A-IPMN subtypes are unknown.

METHODS

Clincopathological features, recurrence patterns and long-term outcomes of patients undergoing pancreatic resection (2010-2020) for A-IPMN were reported from 18 academic pancreatic centres worldwide. Precursor epithelial subtype groups were compared using uni- and multivariate analysis.

RESULTS

In total, 297 patients were included (median age, 70 years; male, 78.9%), including 54 (18.2%) gastric, 111 (37.3%) pancreatobiliary, 80 (26.9%) intestinal and 52 (17.5%) mixed subtypes. Gastric, pancreaticobiliary and mixed subtypes had comparable clinicopathological features, yet the outcomes were significantly less favourable than the intestinal subtype. The median time to recurrence in gastric, pancreatobiliary, intestinal and mixed subtypes were 32, 30, 61 and 33 months. Gastric and pancreatobiliary subtypes had worse overall recurrence (p = 0.048 and p = 0.049, respectively) compared with the intestinal subtype but gastric and pancreatobiliary subtypes had comparable outcomes. Adjuvant chemotherapy was associated with improved survival in the pancreatobiliary subtype (p = 0.049) but not gastric (p = 0.992), intestinal (p = 0.852) or mixed subtypes (p = 0.723). In multivariate survival analysis, adjuvant chemotherapy was associated with a lower likelihood of death in pancreatobiliary subtype, albeit with borderline significance [hazard ratio (HR) 0.56; 95% confidence interval (CI) 0.31-1.01; p = 0.058].

CONCLUSIONS

Gastric, pancreatobiliary and mixed subtypes have comparable recurrence and survival outcomes, which are inferior to the more indolent intestinal subtype. Pancreatobiliary subtype may respond to adjuvant chemotherapy and further research is warranted to determine the most appropriate adjuvant chemotherapy regimens for each subtype.

摘要

背景

源于胰管内乳头状黏液性肿瘤（IPMN）的腺上皮前体上皮亚型的临床肿瘤学结局仅限于小队列研究。目前尚不清楚不同亚型的复发模式和对辅助化疗的反应。

方法

报告了来自全球 18 个学术胰腺中心的患者在接受胰腺切除术（2010-2020 年）治疗 IPMN 后的临床病理特征、复发模式和长期结局。使用单变量和多变量分析比较前体上皮亚型组。

结果

共纳入 297 例患者（中位年龄 70 岁；男性占 78.9%），包括胃 54 例（18.2%）、胰胆管 111 例（37.3%）、肠 80 例（26.9%）和混合 52 例（17.5%）。胃、胰胆管和混合亚型具有相似的临床病理特征，但结局明显不如肠亚型。胃、胰胆管、肠和混合亚型的中位复发时间分别为 32、30、61 和 33 个月。胃和胰胆管亚型的总体复发率明显高于肠亚型（p=0.048 和 p=0.049），但胃和胰胆管亚型的结局相似。辅助化疗与胰胆管亚型的生存改善相关（p=0.049），但与胃（p=0.992）、肠（p=0.852）或混合亚型（p=0.723）无关。在多变量生存分析中，辅助化疗与胰胆管亚型死亡的可能性降低相关，尽管具有边缘显著性[风险比（HR）0.56；95%置信区间（CI）0.31-1.01；p=0.058]。