Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 17;8(5):845-859.
doi: 10.1002/ags3.12790. eCollection 2024 Sep.

Is multidisciplinary treatment effective for invasive intraductal papillary mucinous carcinoma?

Affiliations

Is multidisciplinary treatment effective for invasive intraductal papillary mucinous carcinoma?

Seiko Hirono et al. Ann Gastroenterol Surg. .

Abstract

Background: Surgical resection is standard treatment for invasive intraductal papillary mucinous carcinoma (IPMC); however, impact of multidisciplinary treatment on survival including postoperative adjuvant therapy (AT), neoadjuvant therapy (NAT), and treatment for recurrent lesions is unclear. We investigated the effectiveness of multidisciplinary treatment in prolonging survival of patients with invasive IPMC.

Methods: This retrospective multi-institutional study included 1183 patients with invasive IPMC undergoing surgery at 40 academic institutions. We analyzed the effects of AT, NAT, and treatment for recurrence on survival of patients with invasive IPMC.

Results: Completion of the planned postoperative AT for 6 months improved the overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) of patients with stage IIB and stage III resected invasive IPMC, elevated preoperative carbohydrate antigen 19-9 level, lymphovascular invasion, perineural invasion, serosal invasion, and lymph node metastasis on un-matched and matched analyses. Of the patients with borderline resectable (BR) invasive IPMC, the OS (p = 0.001), DSS (p = 0.001), and RFS (p = 0.001) of patients undergoing NAT was longer than that of those without on the matched analysis. Of the 484 invasive IPMC patients (40.9%) who developed recurrence after surgery, the OS of 365 patients who received any treatment for recurrence was longer than that of those without treatment (40.6 vs. 22.4 months, p < 0.001).

Conclusion: Postoperative AT might benefit selected patients with invasive IPMC, especially those at high risk of poor survival. NAT might improve the survivability of BR invasive IPMC. Any treatment for recurrence after surgery for invasive IPMC might improve survival.

Keywords: invasive IPMC; multidisciplinary treatment; neoadjuvant therapy; postoperative adjuvant therapy; recurrence.

PubMed Disclaimer

Conflict of interest statement

Author SH was supported by grants from the Japan Pancreas Society. Author MU was supported by grants from Taiho Pharma, however, the funding source had no role in the design, practice, or analysis of this study. Author SS was supported by grants from Nihon Servier, Amino‐Up co, however, the funding source had no role in the design, practice, or analysis of this study. Authors HN, KH, and HY are editorial board members of Annals of Gastroenterological Surgery. Authors SH, IE, and AH are associate editors of Annals of Gastroenterological Surgery.

Figures

FIGURE 1
FIGURE 1
The overall survival (OS) (p < 0.001), disease‐specific survival (DSS) (p < 0.001), and recurrence‐free survival (RFS) (p < 0.001) of invasive intraductal papillary mucinous carcinoma (IPMC) were significantly shortened as the AJCC/UICC stage advanced.
FIGURE 2
FIGURE 2
Completion of the planned postoperative adjuvant therapy (AT) for 6 months could prolong the OS, DSS, and RFS for patients with invasive IPMC with high preoperative carbohydrate antigen 19–9 level (A–C), lymphovascular invasion (D–F), perineural invasion (G–I), serosal invasion (J–L), and lymph node metastasis (M‐O).
FIGURE 3
FIGURE 3
Of the 333 patients who completed the postoperative AT, the OS (p = 0.001), DSS (p = 0.001), and RFS (p = 0.001) of those whose regimen was S‐1 monotherapy (n = 226) were significantly better than those whose regimen was gemcitabine (GEM) monotherapy (n = 97) or combination therapy with GEM and S‐1 (GS) (n = 10).
FIGURE 4
FIGURE 4
Of the 70 patients with borderline resectable (BR) invasive IPMC, (A) the OS (p = 0.027) and (B) DSS (p = 0.040) of the 14 patients who received neoadjuvant therapy (NAT) followed by surgery and completion of postoperative AT were significantly better than the other 56 patients with BR invasive IPMC, although the difference in (C) RFS between them did not reach statistical significance (p = 0.088).
FIGURE 5
FIGURE 5
(A) Of the 484 patients who developed any recurrence after surgery for invasive IPMC, the OS of 365 patients receiving any treatment for the recurrence was significantly better than that of those who did not (p < 0.001). (B) In the 94 patients who developed remnant pancreatic recurrence, the OS of 63 patients who underwent surgical resection for remnant pancreatic recurrence was significantly better than that of the 31 patients who did not (p < 0.001).

References

    1. Tanaka M, Fernández‐del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17(5):738–753. - PubMed
    1. Tjaden C, Sandini M, Mihaljevic A, Kaiser J, Khristenko E, Mayer P, et al. Risk of the watch‐and‐wait concept in surgical treatment of intraductal papillary mucinous neoplasm. JAMA Surg. 2021;156(9):818–825. - PMC - PubMed
    1. Hirono S, Kawai M, Okada KI, Miyazawa M, Shimizu A, Kitahata Y, et al. Long‐term surveillance is necessary after operative resection for intraductal papillary mucinous neoplasm of the pancreas. Surgery. 2016;160(2):306–317. - PubMed
    1. Fischer CG, Guthrie VB, Braxton AM, Zheng L, Wang P, Song Q, et al. Intraductal papillary mucinous neoplasms arise from multiple independent clones, each with distinct mutations. Gastroenterology. 2019;154(4):1123–1137. - PMC - PubMed
    1. Duconseil P, Pērinel J, Autret A, Adham M, Sauvanet A, Chiche L, et al. Resectable invasive IPMN versus sporadic pancreatic adenocarcinoma of the head of the pancreas: should these two different diseases receive the same treatment? A matched comparison study of the French surgical association (AFC). Eur J Surg Oncol. 2017;43(9):1704–1710. - PubMed

LinkOut - more resources