背景:导管内乳头状黏液性肿瘤(IPMN)衍生的胰腺导管腺癌(PDAC)与其生物学上不同的对应物相比,切除的尺寸较小,胰腺上皮内瘤变(PanIN)衍生的PDAC。因此,专家建议对IPMN衍生的PDAC进行T1子分期。然而,这从未得到验证。
方法:对来自5个国际高容量中心的IPMN衍生PDAC的连续前期手术患者进行分类,并使用侵入性组件尺寸,按照建议的T1亚分期分类(T1a≤0.5,T1b>0.5和≤1.0,T1c>1.0和≤2.0cm)。使用Kaplan-Meier和对数秩检验来比较总生存期(OS)。多变量Cox回归用于确定具有置信区间(95CI)的风险比(HR)。
结果:在747名患者中,69(9.2%),50(6.7%),99(13.0%),531名患者(71.1%),包括T1a,T1b,T1c,和T2-4子组,分别。T期增加与CA19-9升高,较差等级相关,节点阳性,R1-margin,和管状亚型。T1a的中位操作系统,T1b,T1c,T2-4为159.0(95CI:126.0-NR),128.8(98.3-NR),77.6(48.3-108.2),和31.4(27.5-37.7)个月,分别(p<.001)。对于所有成对比较,OS随着T分期的增加而降低(所有p<0.05)。风险调整后,年龄>65,CA19-9升高,T1b[HR:2.55(1.22-5.32)],T1c[HR:3.04(1.60-5.76)],和T2-4[HR:3.41(1.89-6.17)]与T1a相比,节点阳性,R1-margin,无辅助化疗与OS恶化相关。与T1a(18.2%)相比,T2-4肿瘤的疾病复发更为常见(56.4%),T1b(23.9%),和T1c(36.1%,p<.001)。
结论:T1亚分期的IPMN衍生的PDAC是有效的,具有显著的预后价值。T1子阶段的进展与组织病理学恶化有关,生存,和复发。T1子分期建议用于将来的指南。
BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) is resected at smaller sizes compared to its biologically distinct counterpart, pancreatic intraepithelial neoplasia (PanIN)-derived PDAC. Thus, experts proposed T1 sub-staging for IPMN-derived PDAC. However, this has never been validated.
METHODS: Consecutive upfront surgery patients with IPMN-derived PDAC from five international high-volume centers were classified by the proposed T1 sub-staging classification (T1a ≤ 0.5, T1b > 0.5 and ≤1.0, and T1c >1.0 and ≤2.0 cm) using the invasive component size. Kaplan-Meier and log-rank tests were utilized to compare overall survival (OS). A multivariable Cox-regression was used to determine hazard ratios (HR) with confidence intervals (95%CI).
RESULTS: Among 747 patients, 69 (9.2%), 50 (6.7%), 99 (13.0%), and 531 patients (71.1%), comprised the T1a, T1b, T1c, and T2-4 subgroups, respectively. Increasing T-stage was associated with elevated CA19-9, poorer grade, nodal positivity, R1-margin, and tubular subtype. Median OS for T1a, T1b, T1c, and T2-4 were 159.0 (95%CI:126.0-NR), 128.8 (98.3-NR), 77.6 (48.3-108.2), and 31.4 (27.5-37.7) months, respectively (p < .001). OS decreased with increasing T-stage for all pairwise comparisons (all p < .05). After risk-adjustment, age > 65, elevated CA19-9, T1b [HR : 2.55 (1.22-5.32)], T1c [HR : 3.04 (1.60-5.76)], and T2-4 [HR : 3.41 (1.89-6.17)] compared to T1a, nodal positivity, R1-margin, and no adjuvant chemotherapy were associated with worse OS. Disease recurrence was more common in T2-4 tumors (56.4%) compared to T1a (18.2%), T1b (23.9%), and T1c (36.1%, p < .001).
CONCLUSIONS: T1 sub-staging of IPMN-derived PDAC is valid and has significant prognostic value. Advancing T1 sub-stage is associated with worse histopathology, survival, and recurrence. T1 sub-staging is recommended for future guidelines.