Surgical oncology · 2026
Distinct clinicopathologic features and efficacy of adjuvant therapy in intraductal papillary mucinous carcinoma compared with conventional pancreatic ductal adenocarcinoma.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Yun Won-Gun, Han Youngmin, Lee Inhyuck, Choi Go-Won, Seo Younsoo, Chae Yoon Soo, Cho Young Jae, Jung Hye-Sol, Park Joon Seong, Jang Jin-Young, Kwon Wooil
Аннотация
BACKGROUND: Although current treatment recommendations for intraductal papillary mucinous carcinoma (IPMC) and conventional pancreatic ductal adenocarcinoma (cPDAC) are similar, prior studies suggest differences in tumor biology. Therefore, we aimed to evaluate the clinical features and efficacy of adjuvant treatment for IPMC and cPDAC.
METHODS: Between 2005 and 2022, 60, 100 and 951 patients were histologically diagnosed with colloid IPMC, tubular IPMC and cPDAC, respectively, after upfront surgery. Clinical variables and survival outcomes were compared among the three groups, and the efficacy of adjuvant treatment was examined.
RESULTS: Tumor aggressiveness increased progressively from colloid IPMC to tubular IPMC and cPDAC, with higher frequencies of lymphatic, venous, and perineural invasion (all P < 0.001). The 5-year overall survival rates differed significantly across groups: 70.8% for colloid IPMC, 36.8% for tubular IPMC, and 30.2% for cPDAC (P < 0.001). Recurrence rates were lowest in colloid IPMC (28.3%) and highest in cPDAC (66.2%). In subgroup analyses, adjuvant chemotherapy improved survival only in cPDAC (5-year overall survival: 34.8% vs. 12.6%, P < 0.001), whereas we did not demonstrate a significant association with survival in either histological subtype of IPMC. In multivariate analysis limited to IPMC, only pathological stage and R1 resection margin independently predicted worse survival outcomes.
CONCLUSIONS: Clinical features and prognosis differ considerably among colloid IPMC, tubular IPMC, and cPDAC. Unlike cPDAC, where systemic treatment significantly improves prognosis, favorable outcomes in IPMC depend primarily on early detection and R0 resection. Developing effective adjuvant treatment strategies tailored for IPMC is therefore essential.
METHODS: Between 2005 and 2022, 60, 100 and 951 patients were histologically diagnosed with colloid IPMC, tubular IPMC and cPDAC, respectively, after upfront surgery. Clinical variables and survival outcomes were compared among the three groups, and the efficacy of adjuvant treatment was examined.
RESULTS: Tumor aggressiveness increased progressively from colloid IPMC to tubular IPMC and cPDAC, with higher frequencies of lymphatic, venous, and perineural invasion (all P < 0.001). The 5-year overall survival rates differed significantly across groups: 70.8% for colloid IPMC, 36.8% for tubular IPMC, and 30.2% for cPDAC (P < 0.001). Recurrence rates were lowest in colloid IPMC (28.3%) and highest in cPDAC (66.2%). In subgroup analyses, adjuvant chemotherapy improved survival only in cPDAC (5-year overall survival: 34.8% vs. 12.6%, P < 0.001), whereas we did not demonstrate a significant association with survival in either histological subtype of IPMC. In multivariate analysis limited to IPMC, only pathological stage and R1 resection margin independently predicted worse survival outcomes.
CONCLUSIONS: Clinical features and prognosis differ considerably among colloid IPMC, tubular IPMC, and cPDAC. Unlike cPDAC, where systemic treatment significantly improves prognosis, favorable outcomes in IPMC depend primarily on early detection and R0 resection. Developing effective adjuvant treatment strategies tailored for IPMC is therefore essential.