An international multi-institutional validation of T1 sub-staging of intraductal papillary mucinous neoplasm-derived pancreatic cancer.

Autor:	Habib JR; Department of Surgery, New York University Langone Health, New York, NY, USA.; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands., Rompen IF; Department of Surgery, New York University Langone Health, New York, NY, USA.; Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany., Campbell BA; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA., Andel PCM; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands., Kinny-Köster B; Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany., Damaseviciute R; Department of Surgery, New York University Langone Health, New York, NY, USA., Brock Hewitt D; Department of Surgery, New York University Langone Health, New York, NY, USA., Sacks GD; Department of Surgery, New York University Langone Health, New York, NY, USA., Javed AA; Department of Surgery, New York University Langone Health, New York, NY, USA., Besselink MG; Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Amsterdam, The Netherlands., van Santvoort HC; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands., Daamen LA; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.; Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands., Loos M; Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany., He J; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA., Quintus Molenaar I; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.; Department of Surgery, Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands., Büchler MW; Department of Surgery, Champalimaud Foundation, Lisbon, Portugal., Wolfgang CL; Department of Surgery, New York University Langone Health, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Journal of the National Cancer Institute [J Natl Cancer Inst] 2024 Nov 01; Vol. 116 (11), pp. 1791-1797.
DOI:	10.1093/jnci/djae166
Abstrakt:	Background: Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) is resected at smaller sizes compared with 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 5 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 used to compare overall survival (OS). A multivariable Cox regression was used to determine hazard ratios (HRs) with confidence intervals (95% CIs). 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 to NR), 128.8 (98.3 to NR), 77.6 (48.3 to 108.2), and 31.4 (27.5 to 37.7) months, respectively (P < .001). OS decreased with increasing T-stage for all pairwise comparisons (all P < .05). After risk adjustment, older than age 65, elevated CA19-9, T1b [HR = 2.55 (1.22 to 5.32)], T1c [HR = 3.04 (1.60 to 5.76)], and T2-4 [HR = 3.41 (1.89 to 6.17)] compared with 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 with T1a (18.2%), T1b (23.9%), and T1c (36.1%, P < .001). Conclusion: 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. (© The Author(s) 2024. Published by Oxford University Press.)
Databáze:	MEDLINE
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