Adjuvant chemotherapy seems beneficial for invasive intraductal papillary mucinous neoplasms

Caponi, S.; Vasile, Enrico; Funel, Niccola; Lio, Nelide De; Campani, Daniela; Ginocchi, Laura; Lucchesi, M; Caparello, Chiara; Lencioni, Monica; Cappelli, Carla; Costa, Francesca; Pollina, Le; Ricci, Sergio; Mosca, Franco; Falcone, Alfredo; Boggi, Ugo

doi:10.1016/j.ejso.2012.12.005

Cited by 40 publications

(42 citation statements)

References 45 publications

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“…Second, the lack of disease‐specific mortality or recurrence data precluded adjustment for age‐related or comorbidity‐related mortality or assessment of disease‐specific survival, respectively; nevertheless, the high rate of disease‐related mortality associated with invasive IPMN and PDAC support the use of OS as a valid endpoint. This premise is further supported by data demonstrating a benefit from adjuvant therapy compared with surgery alone for both disease‐free survival and OS among patients with invasive IPMN …”

Section: Discussionmentioning

confidence: 73%

“…In 2012, a propensity score‐matched analysis revealed that patients with advanced T‐classification and LN involvement demonstrated improved survival with adjuvant radiotherapy . The most recent study comparing adjuvant therapy with surgery alone for invasive IPMN reported that patients who received adjuvant chemotherapy experienced longer disease‐free survival than those who underwent surgery alone . It is noteworthy that subgroup analyses identified a significant increase in disease‐free survival for both LN‐positive and LN‐negative disease; however, adjuvant therapy improved OS in only the subset of patients with involved LNs.…”

Section: Discussionmentioning

confidence: 99%

“…This premise is further supported by data demonstrating a benefit from adjuvant therapy compared with surgery alone for both disease-free survival and OS among patients with invasive IPMN. 14 Additional limitations include the inability to account for several treatment-related details: 1) specific chemotherapy regimens used, 2) completion of prescribed treatment schedules, and 3) relative toxicities of chemoradiotherapy versus chemotherapy alone. Other limitations, which are characteristics of retrospective database analyses, include bias from unknown data and misclassification of adjuvant therapy receipt, which could underestimate or overestimate the effects of adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

“…5,12 Current adjuvant therapy recommendations for patients with invasive IPMN are often influenced by experiences with resected conventional PDAC. 4,8,13 In reality, contemporary adjuvant therapy decisions for invasive IPMN have largely been derived from small, underpowered studies 7,13,14 that were insufficient for subgroup assessments of long-term survival.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy of adjuvant therapy for pancreatic invasive intraductal papillary mucinous neoplasm (IPMN)

McMillan

Lewis

Drebin

et al. 2015

Cancer

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BACKGROUND:The literature investigating pancreatic invasive intraductal papillary mucinous neoplasm (IPMN) has largely come from small institutional studies, preventing adequately powered comparisons of adjuvant therapy versus surgery alone (SA) within specific patient subgroups. METHODS: Patients with resected, stage I through IV, invasive IPMN and conventional pancreatic ductal adenocarcinoma (PDAC) were identified in the National Cancer Data Base (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). Cox modeling of patients with invasive IPMN was used to compare overall survival (OS) between patients who received adjuvant therapy and those who underwent SA. A second model was used to compare OS between patients with invasive IPMN and those with PDAC. RESULTS: For the 1220 patients with invasive IPMN, the median OS was 28.9 months; the 1-year and 5-year actuarial survival rates were 76% and 17%, respectively; and 47% received adjuvant therapy. Cox modeling associated SA with worse OS (hazard ratio, 1.36; 95% confidence interval, 1.17-1.58; P 5.00005) as well as American Joint Committee on Cancer (AJCC) TNM stage III/IV disease, positive lymph node status, positive margins, and poor tumor differentiation (all P .05). In addition, Cox modeling stratified by the following characteristics demonstrated improved OS with adjuvant therapy: AJCC TNM stage II or III/IV, positive lymph node status, positive margins, and poorly differentiated tumors. There was no survival advantage from adjuvant therapy for patients who had AJCC TNM stage I or lymph node-negative disease. Patients who had invasive IPMN had improved risk-adjusted OS compared with those who had PDAC (hazard ratio, 0.73; 95% confidence interval, 0.68-0.78; P <.00001). CONCLUSIONS: Invasive IPMN appears to be more indolent than conventional PDAC. Adjuvant therapy is associated with improved OS compared with SA in patients with invasive

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The efficacy of adjuvant therapy for pancreatic invasive intraductal papillary mucinous neoplasm (IPMN)

McMillan

Lewis

Drebin

et al. 2015

Cancer

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“…There are studies demonstrating the development of recurrent lesions in the remaining pancreas within 3 to 6 years following the operations of patients for noninvasive IPMN. 62,63 Caponi et al 64 have demonstrated that lymph node negative patients with invasive IPMN, including well to moderately differentiated tumor cells, had a longer postoperative general survival rate. It was also demonstrated in the study that adjuvant chemotherapy including gemcitabine was effective in extending the survival periods.…”

Section: Treatment Optionsmentioning

confidence: 99%

Intraductal Papillary Mucinous Neoplasm of the Pancreas: Current Perspectives

Dumlu

Karakoç

Özdemir

2015

International Surgery

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In this article, we aimed to review the literature on the clinics and management of intraductal papillary mucinous neoplasm (IPMN). Intraductal papillary mucinous neoplasm of the pancreas is a mucin-producing cystic mass originating from the pancreatic ductal system. Approximately 25% of the pancreatic neoplasms resected surgically and 50% of pancreatic cysts detected incidentally are IPMNs. They can be benign or malignant in character, while malignant transformation of benign forms can be encountered. It is important to determine IPMNs in the early stages, implementation of appropriate treatment approaches, and follow-up to provide better prognosis. We reviewed the studies published in the English medical literature through PubMed and summarized the clinical features and current approaches to the treatment and follow-up of the IPMN. Due to the recent advances and widespread implementation of radiological imaging techniques, the incidental detection rate of IPMNs has increased significantly. The effective treatment of the disease is possible via the detailed diagnosis of the disease, determination of the prognostic factors, and a multidisciplinary approach. Recent literature also emphasized the molecular profile determination approaches for assessment of prognosis of patients with IPMN. Current knowledge on IPMN, a clinically important epidemiologic problem, shows that the treatment should be personalized considering the prognostic features and life expectancy of the patient.

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Analyzing and predicting the LNM rate and prognosis of patients with intraductal papillary mucinous neoplasm of the pancreas

et al. 2021

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Background Current the surveillance and management are controversial for patients with IPMN. We aimed to develop an alternative nomogram to individualize IPMN prognosis and LNM. Methods Based on the data from SEER database of patients diagnosed with IPMN between 2004 and 2015, a nomogram predicting the survival and LNM of IPMN based on univariate and multivariate and Lasso regression analysis was performed, internally and externally validated, and measured by C‐index, and decision curve analysis (DCA), and compared to the 7th TNM stage. Results A total of 941 patients were included. Age, T stage examined nodes, tumor size, and pathology grade were identified as an independent factor for predicting LNM. The nomogram we established to predict LNM had a high predicting value with a C‐index value of 0.735 and an AUC value of 0.753. Interestingly, including T1 stage, we found an inverse correlation was between age and LNM. In addition, nomogram for predicting CSS also performed better than TNM stage both in the internal validation group (1‐year AUC:0.753 vs. 0.693, 3‐year AUC: 0.801 vs. 0.731, 5‐year AUC: 0.803 vs. 0.733) and external validation group (1‐year AUC: 0.761 vs. 0.701, 3‐year AUC: 0.772 vs. 0.713, 5‐year AUC:0.811 vs. 0.735). DCA analysis showed the nomogram showed a greater benefit across the period of follow‐up compared to 7th TNM stage. Conclusion A nomogram based on multivariate and Lasso regression analysis showed great clinical usability compared with current criteria. Also, for LNM of IPMN, younger age patients with IPMN should be attached more importance.

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Adjuvant chemotherapy seems beneficial for invasive intraductal papillary mucinous neoplasms

Cited by 40 publications

References 45 publications

The efficacy of adjuvant therapy for pancreatic invasive intraductal papillary mucinous neoplasm (IPMN)

The efficacy of adjuvant therapy for pancreatic invasive intraductal papillary mucinous neoplasm (IPMN)

Intraductal Papillary Mucinous Neoplasm of the Pancreas: Current Perspectives

Analyzing and predicting the LNM rate and prognosis of patients with intraductal papillary mucinous neoplasm of the pancreas

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