背景:由导管内乳头状黏液性肿瘤(A-IPMN)引起的腺癌上皮亚型前体的临床肿瘤学结果仅限于小型队列研究。A-IPMN亚型之间的复发模式和对辅助化疗的反应差异尚不清楚。
方法:临床病理学特征,在全球18个学术胰腺中心报告了接受A-IPMN胰腺切除术(2010-2020)的患者的复发模式和长期结局.使用单和多变量分析比较前体上皮亚型组。
结果:总计,纳入297例患者(中位年龄,70岁;男性,78.9%),包括54(18.2%)胃部,111(37.3%)胰胆管,80(26.9%)个肠道混杂亚型和52(17.5%)个。胃,胰胆管和混合亚型具有相当的临床病理特征,然而,结局明显不如肠道亚型.胃复发的中位时间,胰胆管,肠道和混合亚型分别为32、30、61和33个月。与肠道亚型相比,胃和胰胆管亚型的总体复发较差(分别为p=0.048和p=0.049),但胃和胰胆管亚型的预后相当。辅助化疗与胰胆管亚型(p=0.049)而不是胃(p=0.992)的生存率提高有关,肠(p=0.852)或混合亚型(p=0.723)。在多变量生存分析中,辅助化疗与胰胆管亚型的死亡可能性较低相关,尽管具有临界显著性[风险比(HR)0.56;95%置信区间(CI)0.31-1.01;p=0.058]。
结论:胃,胰胆管和混合亚型具有相当的复发和生存结果,劣于较惰性的肠道亚型。胰胆管亚型可能对辅助化疗有反应,需要进一步研究以确定每种亚型的最合适的辅助化疗方案。
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.