학술논문
Long-term Outcomes following Resection of Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasm (A-IPMN) versus Pancreatic Ductal Adenocarcinoma (PDAC): A Propensity-score Matched Analysis
Document Type
Academic Journal
Author
Lucocq, James; Halle-Smith, James; Haugk, Beate; Joseph, Nejo; Hawkyard, Jake; Lye, Jonathan; Parkinson, Daniel; White, Steve; Mownah, Omar; Zen, Yoh; Menon, Krishna; Furukawa, Takaki; Inoue, Yosuke; Hirose, Yuki; Sasahira, Naoki; Mittal, Anubhav; Samra, Jas; Sheen, Amy; Feretis, Michael; Balakrishnan, Anita; Ceresa, Carlo; Davidson, Brian; Pande, Rupaly; Dasari, Bobby V.M.; Tanno, Lulu; Karavias, Dimitrios; Helliwell, Jack; Young, Alistair; Marks, Kate; Nunes, Quentin; Urbonas, Tomas; Silva, Michael; Gordon-Weeks, Alex; Barrie, Jenifer; Gomez, Dhanny; van Laarhoven, Stijn; Nawara, Hossam; Doyle, Joseph; Bhogal, Ricky; Harrison, Ewen; Roalso, Marcus; Ciprani, Debora; Aroori, Somaiah; Ratnayake, Bathiya; Koea, Jonathan; Capurso, Gabriele; Bellotti, Ruben; Stättner, Stefan; Alsaoudi, Tareq; Bhardwaj, Neil; Rajesh, Srujan; Jeffery, Fraser; Connor, Saxon; Cameron, Andrew; Jamieson, Nigel; Soreide, Kjetil; Gill, Anthony J.; Roberts, Keith; Pandanaboyana, Sanjay
Source
Annals of Surgery. Mar 22, 2024
Subject
Language
English
ISSN
0003-4932
Abstract
OBJECTIVE:: The aim of the present study was to compare long-term post-resection oncological outcomes between A-IPMN and PDAC. SUMMARY BACKGROUND DATA:: Knowledge of long term oncological outcomes (e.g recurrence and survival data) comparing between adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) and pancreatic ductal adenocarcinoma (PDAC) is scarce. METHODS:: Patients undergoing pancreatic resection (2010-2020) for A-IPMN were identified retrospectively from 18 academic pancreatic centres and compared with PDAC patients from the same time-period. Propensity-score matching (PSM) was performed and survival and recurrence were compared between A-IPMN and PDAC. RESULTS:: 459 A-IPMN patients (median age,70; M:F,250:209) were compared with 476 PDAC patients (median age,69; M:F,262:214). A-IPMN patients had lower T-stage, lymphovascular invasion (51.4%vs. 75.6%), perineural invasion (55.8%vs. 71.2%), lymph node positivity (47.3vs. 72.3%) and R1 resection (38.6%vs. 56.3%) compared to PDAC(P<0.001). The median survival and time-to-recurrence for A-IPMN versus PDAC were 39.0 versus19.5months (P<0.001) and 33.1 versus 14.8months (P<0.001), respectively (median follow-up,78 vs.73 months). Ten-year overall survival for A-IPMN was 34.6%(27/78) and PDAC was 9%(6/67). A-IPMN had higher rates of peritoneal (23.0 vs. 9.1%, P<0.001) and lung recurrence (27.8% vs. 15.6%, P<0.001) but lower rates of locoregional recurrence (39.7% vs. 57.8%; P<0.001). Matched analysis demonstrated inferior overall survival (P=0.005), inferior disease-free survival (P=0.003) and higher locoregional recurrence (P<0.001) in PDAC compared to A-IPMN but no significant difference in systemic recurrence rates (P=0.695). CONCLUSIONS:: PDACs have inferior survival and higher recurrence rates compared to A-IPMN in matched cohorts. Locoregional recurrence is higher in PDAC but systemic recurrence rates are comparable and constituted by their own distinctive site-specific recurrence patterns.