Habib Joseph R, Rompen Ingmar F, Javed Ammar A, Grewal Mahip, Kinny-Köster Benedict, Andel Paul C M, Hewitt D Brock, Sacks Greg D, Besselink Marc G, van Santvoort Hjalmar C, Daamen Lois A, Loos Martin, He Jin, Büchler Markus W, Wolfgang Christopher L, Molenaar I Quintus
Department of Surgery, New York University Langone Health, New York, New York, USA.
Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
J Gastroenterol Hepatol. 2024 Nov;39(11):2360-2366. doi: 10.1111/jgh.16686. Epub 2024 Jul 31.
Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) management is generally extrapolated from pancreatic intraepithelial neoplasia (PanIN)-derived PDAC guidelines. However, these are biologically divergent, and heterogeneity further exists between tubular and colloid subtypes.
Consecutive upfront surgery patients with PanIN-derived and IPMN-derived PDAC were retrospectively identified from international centers (2000-2019). One-to-one propensity score matching for clinicopathologic factors generated three cohorts: IPMN-derived versus PanIN-derived PDAC, tubular IPMN-derived versus PanIN-derived PDAC, and tubular versus colloid IPMN-derived PDAC. Overall survival (OS) was compared using Kaplan-Meier and log-rank tests. Multivariable Cox regression determined corresponding hazard ratios (HR) and 95% confidence intervals (95% CI).
The median OS (mOS) in 2350 PanIN-derived and 700 IPMN-derived PDAC patients was 23.0 and 43.1 months (P < 0.001), respectively. PanIN-derived PDAC had worse T-stage, CA19-9, grade, and nodal status. Tubular subtype had worse T-stage, CA19-9, grade, nodal status, and R1 margins, with a mOS of 33.7 versus 94.1 months (P < 0.001) in colloid. Matched (n = 495), PanIN-derived and IPMN-derived PDAC had mOSs of 30.6 and 42.8 months (P < 0.001), respectively. In matched (n = 341) PanIN-derived and tubular IPMN-derived PDAC, mOS remained poorer (27.7 vs 37.4, P < 0.001). Matched tubular and colloid cancers (n = 112) had similar OS (P = 0.55). On multivariable Cox regression, PanIN-derived PDAC was associated with worse OS than IPMN-derived (HR: 1.66, 95% CI: 1.44-1.90) and tubular IPMN-derived (HR: 1.53, 95% CI: 1.32-1.77) PDAC. Colloid and tubular subtype was not associated with OS (P = 0.16).
PanIN-derived PDAC has worse survival than IPMN-derived PDAC supporting distinct outcomes. Although more indolent, colloid IPMN-derived PDAC has similar survival to tubular after risk adjustment.
导管内乳头状黏液性肿瘤（IPMN）衍生的胰腺导管腺癌（PDAC）的管理通常是从胰腺上皮内瘤变（PanIN）衍生的PDAC指南外推而来。然而，它们在生物学上存在差异，并且在管状和胶样亚型之间进一步存在异质性。
从国际中心（2000 - 2019年）回顾性识别连续接受 upfront 手术的 PanIN 衍生和 IPMN 衍生的 PDAC 患者。对临床病理因素进行一对一倾向评分匹配，产生三个队列：IPMN 衍生与 PanIN 衍生的 PDAC、管状 IPMN 衍生与 PanIN 衍生的 PDAC、以及管状与胶样 IPMN 衍生的 PDAC。使用 Kaplan - Meier 法和对数秩检验比较总生存期（OS）。多变量 Cox 回归确定相应的风险比（HR）和95%置信区间（95%CI）。
2350例 PanIN 衍生和700例 IPMN 衍生的 PDAC 患者的中位 OS（mOS）分别为23.0个月和43.1个月（P < 0.001）。PanIN 衍生的 PDAC 在 T 分期、CA19 - 9、分级和淋巴结状态方面更差。管状亚型在 T 分期、CA19 - 9、分级、淋巴结状态和 R1 切缘方面更差，胶样亚型的 mOS 为94.1个月，而管状亚型为33.7个月（P < 0.001）。匹配（n = 495）的 PanIN 衍生和 IPMN 衍生 PDAC 的 mOS 分别为30.6个月和42.8个月（P < 0.001）。在匹配（n = 341）的 PanIN 衍生和管状 IPMN 衍生的 PDAC 中，mOS 仍然较差（27.7对37.4，P < 0.001）。匹配的管状和胶样癌（n = 112）具有相似的 OS（P = 0.55）。在多变量 Cox 回归中，PanIN 衍生的 PDAC 与比 IPMN 衍生（HR：1.66，95%CI：l.44 - 1.90）和管状 IPMN 衍生（HR：1.53，95%CI：1.32 - 1.77）的 PDAC 更差的 OS 相关。胶样和管状亚型与 OS 无关（P = 0.16）。
PanIN 衍生的 PDAC 比 IPMN 衍生的 PDAC 生存率更差，支持不同的预后。尽管胶样 IPMN 衍生的 PDAC 更惰性，但在风险调整后与管状亚型具有相似的生存率。
