Pancreatic neoplasm histology predicts survival

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1. Pathohistological subtype of pancreatic intraductal papillary mucinous neoplasm (IPMN) was a strong independent predictor for malignancy. 

2. Pancreatobiliary type IPMN was associated with poor prognosis as well as malignant behavior and high recurrence potential. Survival rates were similar to pancreatic ductal adenocarcinoma, a cancer with similar tumor biology, suggesting that adjuvant therapy should be considered for patients diagnosed with pancreatobilary subtype.

Evidence Rating Level: 1 (Excellent)       

Study Rundown: IPMN histology is subdivided into intestinal, pancreatobiliary, gastric and oncologic types which differ by mucin expression. This study examined the relationship between each IPMN subtype, cancer recurrence and patient survival. Individual pathohistologic subtype was a strong independent prognosticator of survival. This study was limited by its restriction to only two cancer referral centers and the low number of cases in each subtype. Given the low incidence of this disease however, the sample size achieved in this study is robust and authors were able to show significant association with survival and recurrence rates. While there was appropriately long individual patient follow up, the entire study spanned 15 years during which time improvement of surgical technique and quality of care may have affected survival results.

Click to read the study in Annals of Surgery

Relevant Reading: Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas: Its Histopathologic Difference Between 2 Major Types

In-Depth [retrospective cohort study]: This study identified 103 cases of IPMN at two medical institutions from 1995 to 2010 with a mean follow-up of 59 months. Post-resection specimens were examined for pathohistologic subtype and duct involvement. The subtypes were divided as follows: 44% intestinal, 40% pancreatobiliary, 4% oncocytic and 12% gastric. No significant difference in CEA or CA 19-9 levels was detected between the subtypes. Pancreatobiliary and intestinal-type tumors were highly associated and moderately associated with invasive carcinoma respectively, while gastric IPMNs had a lower rate of malignancy conversion. Of the malignant subtypes, pancreatobiliary tumors were most likely to recur (p<0.001). Pancreatobiliary IPMN tumors were also associated with the poorest prognosis, demonstrating a 35.6% chance of 5-year survival, compared to 86.6% in the intestinal subtype, which represented the best prognosis. Invasive pancreatobiliary neoplasms were associated with an even lower 5-year survival of 28.1%(mean 38 mo. p<0.001)and were found to be similar to matched patients with pancreatic ductal adenocarcinoma.

By Asya Ofshteyn and Chaz Carrier

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