Adjuvant chemotherapy is associated with improved postoperative survival in specific subtypes of invasive intraductal papillary mucinous neoplasms (IPMN) of the pancreas: it is time for randomized controlled data

Abstract

Background: Very little is known about adjuvant chemotherapy for invasive Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas. The aim was to assess whether adjuvant chemotherapy affects survival. Methods: Retrospective evaluation of invasive IPMNs. Patients treated with surgery alone or followed by adjuvant chemotherapy were compared in terms of survival.Results: A total of 102 invasive IPMNs were analyzed. Median follow-up was 72 (5-318) months and 18.6% received adjuvant chemotherapy. Overall, recurrence rate was 40.2%, while 5-year overall survival and disease specific survival (DSS) were 65.3% and 69.4%, respectively. N1 disease (HR5.58, CI95% 2.49-12.51, p < 0.01), tubular type (HR2.35, CI95% 1.71-4.82, p = 0.05) and G3 tumors (HR4.54, CI95% 2.12-15.49, <0.01) were predictors of reduced DSS. Overall, there was no difference in the 5-year DSS comparing patients treated with adjuvant chemotherapy to surgery alone (61.8 vs. 69.4%, p = 0.8). Adjuvant chemotherapy significantly improved DSS only in N1 (5-years-DSS 76 vs. 35.8%, p = 0.01) and tubular carcinomas (5-years-DSS 88.9 vs. 53%, p = 0.03).Conclusions: Adjuvant therapy improves survival only in invasive IPMNs with nodal disease or tubular differentiation. Future trials are needed to improve the level of evidence about adjuvant chemotherapy.

Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

“…No benefit on survival was noted in patients with stage I and/or node-negative disease (63). Similar results have been shown by Marchegiani and colleagues, suggesting that chemotherapy could confer a survival benefit mainly in patients with node-positive disease of the tubular subtype (64).…”

“…Although these data seem to encourage adjuvant treatment for invasive IPMN, there is a large lack of consensus on chemotherapy regimens. Most patients are treated with gemcitabine alone, while only a few patients are treated with combined drug regimens (64). Moreover, variability in chemotherapy effects could be represented by different histologic subtypes of the invasive component.…”

Prognostic significance of mucinous component in hilar cholangiocarcinoma after curative‐intent resection

“…However, Leng et al suggested that adjuvant radiotherapy was not associated with the improved survival of patients with resected perihilar cholangiocarcinoma. Interestingly, even though adjuvant therapy has been confirmed to improve prognosis in MAC, our findings suggested that postoperative adjuvant chemotherapy was not significantly associated with the RFS and OS of HCM patients in the multivariate analysis. Future large prospective studies are needed to determine which patients are at high risk for adverse prognosis and who might, therefore, benefit from adjuvant therapy.…”

Intraductal papillary mucinous neoplasm of pancreas

“…В таблице приведены основные тактические положения этих рекомендаций. Тактика лечения ВПМО по рекомендациям Международной панкреатологической ассоциации (2017) и Европейским рекомендациям (2018) В рекомендациях IAP2017 признаками высокого риска малигнизации являются механическая желтуха, обусловленная опухолью, наличие в пределах кисты солидного компонента 5 мм и менее, накапливающего контраст, расширение главного ПП до 10 мм и более. Это абсолютные показания к операции.…”

“…В то же время по данным G. Marchegiani и соавт. [46], адъювантная терапия увеличивает продолжительность жизни только при тубулярном подтипе карциномы и вовлеченности лимфатических узлов. Для формирования окончательных выводов требуется дальнейшее изучение этого вопроса.…”