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.
Lucocq J., Halle-Smith J., Haugk B., Joseph N., Hawkyard J., Lye J., Parkinson D., White S., Mownah O., Zen Y., Menon K., Furukawa T., Inoue Y., Hirose Y., Sasahira N., Mittal A., Samra J., Sheen A., Feretis M., Balakrishnan A., Ceresa C., Davidson B., Pande R., Dasari BVM., Tanno L., Karavias D., Helliwell J., Young A., Marks K., Nunes Q., Urbonas T., Silva M., Gordon-Weeks A., Barrie J., Gomez D., van Laarhoven S., Nawara H., Doyle J., Bhogal R., Harrison E., Roalso M., Ciprani D., Aroori S., Ratnayake B., Koea J., Capurso G., Bellotti R., Stättner S., Alsaoudi T., Bhardwaj N., Rajesh S., Jeffery F., Connor S., Cameron A., Jamieson N., Soreide K., Gill AJ., Roberts K., Pandanaboyana S.
OBJECTIVE: The aim of the present study was to compare long-term postresection oncological outcomes between adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) and pancreatic ductal adenocarcinoma (PDAC). BACKGROUND: Knowledge of long-term oncological outcomes (e.g. recurrence and survival) comparing A-IPMN and PDAC is scarce. METHODS: Patients undergoing pancreatic resection (2010-2020) for A-IPMN were identified retrospectively from 18 academic pancreatic centers and compared with PDAC patients from the same time period. Propensity-score matching was performed, and survival and recurrence were compared between A-IPMN and PDAC. RESULTS: In all, 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 (47.3% vs. 72.3%) and R1 resection (38.6% vs. 56.3%) compared with PDAC ( P <0.001). The median survival and time-to-recurrence for A-IPMN versus PDAC were 39.0 versus 19.5 months ( P <0.001) and 33.1 versus 14.8 months ( 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). The 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 with 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.