Prognosis of invasive intraductal papillary mucinous neoplasms of the pancreas

Abstract

Intraductal papillary mucinous neoplasms (IPMN) are mucin producing cystic neoplasms of the pancreas histologically classified as having non-invasive and invasive components. The five-year survival rates for non-invasive and associated invasive carcinoma are 90% and 40%, respectively in resected IPMN lesions. Invasive carcinoma within IPMN lesions can be further classified by histological subtype into colloid carcinoma and tubular carcinoma. Estimated five-year survival rates following resection of colloid carcinoma range from 57%-83% and estimated five-year survival following resection of tubular carcinoma range from 24%-55%. The difference in survival outcome between invasive colloid and tubular IPMN appears to be a function of disease biology, as patients with the tubular subtype tend to have larger tumors with a propensity for metastasis to regional lymph nodes. When matched to resected conventional pancreatic adenocarcinoma lesions by the Memorial Sloan Kettering Cancer Center pancreatic adenocarcinoma nomogram, the colloid carcinoma histological subtype has an improved estimated five-year survival outcome compared to conventional pancreatic adenocarcinoma, 87% and 23% (P = 0.0001), respectively. Resected lesions with the tubular carcinoma subtype overall have a similar five-year survival outcome compared to conventional pancreatic adenocarcinoma. However, when these groups were stratified by regional lymph node status patients with negative regional lymph nodes and the tubular subtype experienced significantly better survival than patients with a similar nodal status and ductal adenocarcinoma with estimated five-year survival rates of 73% and 27% (P = 0.01), respectively.

Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract

“…51, 62, 64, 65, 98–100 About half of the invasive carcinomas that arise in association with an IPMN are ordinary tubular (ductal) adenocarcinoma (Fig. 3A), characterized by infiltrating small to medium tubular units separated by abundant stroma.…”

“…65, 101, 102 Patients with colloid carcinomas have a significantly better prognosis than do patients with tubular invasive carcinomas. 51, 62, 63, 65, 98, 100 Further, both colloid carcinoma and its common precursor, intestinal type IPMN, are characterized by intestinal type differentiation markers - diffuse and strong expression of the intestinal epithelial marker, MUC2, and, the intestinal differentiation marker, CDX2, - neither of which are expressed substantially in any other tumor type in the pancreas. 50–52, 103–105 These render colloid carcinomas a potential candidate for a different management approach, and thus accentuate the importance of its recognition and proper documentation in the pathology reports.…”

Intraductal papillary mucinous neoplasm

“…Several studies have suggested that patients with colloid carcinomas have a better prognosis than do patients with tubular adenocarcinoma [128][129][130]. Some of this, however, is lost when stage is controlled for.…”

Adjuvante Therapie und Nachsorge bei zystischem Malignom

“…umliegender Strukturen. Bei PatiInvasiv wachsende karzinomatöse Tumoranteile finden sich in 24-60% der resezierten Fälle [6], mit 5-Jahres-Überlebens-raten bis 50% und Rezidiven in ca. 60%.…”