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. 2024 Nov;39(11):2360-2366.
doi: 10.1111/jgh.16686. Epub 2024 Jul 31.

Outcomes in intraductal papillary mucinous neoplasm-derived pancreatic cancer differ from PanIN-derived pancreatic cancer

Joseph R Habib  1   2 , Ingmar F Rompen  1   3 , Ammar A Javed  1 , Mahip Grewal  1 , Benedict Kinny-Köster  3 , Paul C M Andel  2 , D Brock Hewitt  1 , Greg D Sacks  1 , Marc G Besselink  4   5 , Hjalmar C van Santvoort  2 , Lois A Daamen  2   6 , Martin Loos  3 , Jin He  7 , Markus W Büchler  8 , Christopher L Wolfgang  1 , I Quintus Molenaar  2
Affiliations

Outcomes in intraductal papillary mucinous neoplasm-derived pancreatic cancer differ from PanIN-derived pancreatic cancer

Joseph R Habib et al. J Gastroenterol Hepatol. 2024 Nov.

Abstract

Background and aim: 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.

Methods: 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).

Results: 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).

Conclusions: 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.

Keywords: colloid; intraductal papillary mucinous neoplasm; invasive IPMN; pancreatic cancer; pancreatic cyst; pancreatic neoplasms; tubular.

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Figures

Figure 1
Figure 1
Kaplan–Meier survival curves comparing overall survival (95% CI) in unmatched (a) and matched (b) patients with PanIN‐derived versus IPMN‐derived PDAC. (a) formula image, IPMN‐derived PDAC; formula image, PanIN‐derived PDAC. (b) formula image, IPMN‐derived PDAC; formula image, PanIN‐derived PDAC.
Figure 2
Figure 2
Kaplan–Meier survival curves comparing overall survival (95% CI) in unmatched (a) and matched (b) patients with PanIN‐derived versus tubular IPMN‐derived PDAC. (a) formula image, Tubular; formula image, PanIN‐derived PDAC. (b) formula image, Tubular; formula image, PanIN‐derived PDAC.
Figure 3
Figure 3
Kaplan–Meier survival curves comparing overall survival (95% CI) in unmatched (a) and matched (b) patients with tubular versus colloid IPMN‐derived PDAC. (a) formula image, Colloid; formula image, Tubular. (b) formula image, Colloid; formula image, Tubular.
See this image and copyright information in PMC

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