Intraductal papillary mucinous neoplasm (IPMN) with high-grade dysplasia is a risk factor for the subsequent development of pancreatic ductal adenocarcinoma

Autor: Bulent Salman, John L. Cameron, Neda Rezaee, Carlotta Barbon, Jin He, Christopher L. Wolfgang, Nita Ahuja, Anne Marie Lennon, Joseph M. Herman, Laura D. Wood, Matthew J. Weiss, Ralph H. Hruban, Ahmed A. Zaki
Rok vydání: 2016
Předmět:
Male
Oncology
medicine.medical_specialty
Pathology
Time Factors
Pancreatic ductal adenocarcinoma
Databases
Factual
endocrine system diseases
medicine.medical_treatment
Kaplan-Meier Estimate
Malignancy
Risk Assessment
Disease-Free Survival
03 medical and health sciences
Pancreatectomy
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Carcinoma
Humans
Neoplasm Invasiveness
Risk factor
Aged
Proportional Hazards Models
Neoplasm Grading
Hepatology
Intraductal papillary mucinous neoplasm
business.industry
Gastroenterology
Neoplasms
Second Primary
Middle Aged
medicine.disease
digestive system diseases
Pancreatic Neoplasms
Treatment Outcome
Dysplasia
Lymphatic Metastasis
030220 oncology & carcinogenesis
Original Article
Female
030211 gastroenterology & hepatology
Neoplasms
Cystic
Mucinous
and Serous
business
Carcinoma
Pancreatic Ductal
Zdroj: HPB. 18:236-246
ISSN: 1365-182X
DOI: 10.1016/j.hpb.2015.10.010
Popis: Non-invasive intraductal papillary mucinous neoplasm (IPMN) with high-grade dysplasia and IPMN-associated invasive pancreatic ductal adenocarcinoma (PDAC) are frequently included under the term "malignancy". The goal of this study is to clarify the difference between these two entities.From 1996 to 2013, data of 616 patients who underwent pancreatic resection for an IPMN were reviewed.The median overall survival for patients with IPMN with high-grade dysplasia (92 months) was similar to survival for patients with IPMN with low/intermediate-grade dysplasia (118 months, p = 0.081), and superior to that of patients with IPMN-associated PDAC (29 months, p 0.001). IPMN-associated PDAC had lymph node metastasis in 53%, perineural invasion in 58%, and vascular invasion in 33%. In contrast, no lymph node metastasis, perineural or vascular invasion was observed with high-grade dysplasia. None of the patients with IPMN with high-grade dysplasia developed recurrence outside the remnant pancreas. In stark contrast 58% of patients with IPMN-associated PDAC recurred outside the remnant pancreas. The rate of progression within the remnant pancreas was significant in patients with IPMN with high-grade (24%) and with low/intermediate dysplasia (22%, p = 0.816).Non-invasive IPMN with high-grade dysplasia should not be considered a malignant entity. Compared to patients with IPMN with low/intermediate-grade dysplasia, those with high-grade dysplasia have an increased risk of subsequent development of PDAC in the remnant pancreas.
Databáze: OpenAIRE
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