The controversial role of adjuvant therapy in node negative invasive IPMN

Crocè, C; Mungo, Benedetto; Ahrendt, Steven A.; Gleisner, Ana; Oba, A.; Friedman, Chloe; Schulick, Richard D.; Chiaro, Marco Del

doi:10.1016/j.pan.2020.07.055

Cited by 2 publications

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“…All studies were retrospective in nature. Studies were performed in the USA ( n = 7) [ 9 , 10 , 13 , 15 , 16 , 25 , 26 ], Italy ( n = 2) [ 11 , 14 ], France ( n = 1) [ 12 ], and Japan ( n = 1) [ 27 ]. The total number of patients from the included studies was 3393, and all patients had the diagnosis of IIPMNs.…”

Section: Resultsmentioning

confidence: 99%

“…IIPMNs diagnosis was made with clear exclusion of IPMNs with concomitant PDAC in three studies [ 10 , 11 , 27 ]. In the remainder of eight studies, IPMNs with concomitant PDAC were not clearly excluded when diagnosing IIPMNs [ 9 , 12 – 16 , 25 , 26 ]. Overall, 1535 patients received adjuvant chemotherapy and 1858 patients received surgery alone (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Gemcitabine-based adjuvant chemotherapy was utilised for 65.0% (91/140) patients, 5-fluorouracil (5-FU)-based for 33.6% (47/140) patients, 5-FU/gemcitabine for 0.7% (1/140) patients, and capecitabine alone for 0.7% (1/140) patients. Eight studies reported the use of additional adjuvant radiotherapy in addition to chemotherapy [ 10 , 11 , 13 – 16 , 25 , 26 ], in 61.2% patients (868/1419) (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Table 3 summarises pathologic features of IIPMNs that predicted a survival benefit from adjuvant chemotherapy as reported in the literature. A meta-analysis of these pathologic features was not performed due to under-reporting or [11,14,16,25,26]. Three studies assessed the role of adjuvant chemotherapy in patients with positive resection margin [11,15,16], and one found a survival benefit compared to those who underwent surgery alone [16].…”

Section: Pathologic Features Of Invasive Ipmn That Predicted Survival Benefit From Adjuvant Chemotherapymentioning

confidence: 99%

“…Multivariate or propensity-weighted analysis was employed by two studies to distinguish treatment effect of adjuvant chemotherapy [13,25]. OS in node-positive patients was significantly improved after adjuvant chemotherapy in both studies [25].…”

Section: Pathologic Features Of Invasive Ipmn That Predicted Survival Benefit From Adjuvant Chemotherapymentioning

confidence: 99%

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Adjuvant Chemotherapy in the Treatment of Intraductal Papillary Mucinous Neoplasms of the Pancreas: Systematic Review and Meta‐Analysis

et al. 2021

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Background The present systematic review aimed to compare survival outcomes of invasive intraductal papillary mucinous neoplasms (IIPMNs) treated with adjuvant chemotherapy versus surgery alone and to identify pathologic features that may predict survival benefit from adjuvant chemotherapy. Method A systematic search of MEDLINE, PubMed, Scopus, and EMBASE was performed using the PRISMA framework. Studies comparing adjuvant chemotherapy and surgery alone for patients with IIPMNs were included. Primary endpoint was overall survival (OS). A narrative synthesis was performed to identify pathologic features that predicted survival benefits from adjuvant chemotherapy. Results Eleven studies and 3393 patients with IIPMNs were included in the meta-analysis. Adjuvant chemotherapy significantly reduced the risk of death in the overall cohort (HR 0.57, 95% CI 0.38–0.87, p = 0.009) and node-positive patients (HR 0.29, 95% CI 0.13–0.64, p = 0.002). Weighted median survival difference between adjuvant chemotherapy and surgery alone in node-positive patients was 11.6 months (95% CI 3.83–19.38, p = 0.003) favouring chemotherapy. Adjuvant chemotherapy had no impact on OS in node-negative patients (HR 0.53, 95% CI 0.20–1.43, p = 0.209). High heterogeneity (I2 > 75%) was observed in pooled estimates of hazard ratios. Improved OS following adjuvant chemotherapy was reported for patients with stage III/IV disease, tumour size > 2 cm, node-positive status, grade 3 tumour differentiation, positive margin status, tubular carcinoma subtype, and presence of perineural or lymphovascular invasion. Conclusion Adjuvant chemotherapy was associated with improved OS in node-positive IIPMNs. However, the findings were limited by marked heterogeneity. Future large multicentre prospective studies are needed to confirm these findings and explore additional predictors of improved OS to guide patient selection for adjuvant chemotherapy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Pathologic Features Of Invasive Ipmn That Predicted Survival Benefit From Adjuvant Chemotherapymentioning

confidence: 99%

Section: Pathologic Features Of Invasive Ipmn That Predicted Survival Benefit From Adjuvant Chemotherapymentioning

confidence: 99%

See 3 more Smart Citations

Adjuvant Chemotherapy in the Treatment of Intraductal Papillary Mucinous Neoplasms of the Pancreas: Systematic Review and Meta‐Analysis

et al. 2021

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Intraductal Papillary Mucinous Carcinoma Versus Conventional Pancreatic Ductal Adenocarcinoma: A Comprehensive Review of Clinical-Pathological Features, Outcomes, and Molecular Insights

Mas

Lupinacci

Cros

et al. 2021

IJMS

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Intraductal papillary mucinous neoplasms (IPMN) are common and one of the main precursor lesions of pancreatic ductal adenocarcinoma (PDAC). PDAC derived from an IPMN is called intraductal papillary mucinous carcinoma (IPMC) and defines a subgroup of patients with ill-defined specificities. As compared to conventional PDAC, IPMCs have been associated to clinical particularities and favorable pathological features, as well as debated outcomes. However, IPMNs and IPMCs include distinct subtypes of precursor (gastric, pancreato-biliary, intestinal) and invasive (tubular, colloid) lesions, also associated to specific characteristics. Notably, consistent data have shown intestinal IPMNs and associated colloid carcinomas, defining the “intestinal pathway”, to be associated with less aggressive features. Genomic specificities have also been uncovered, such as mutations of the GNAS gene, and recent data provide more insights into the mechanisms involved in IPMCs carcinogenesis. This review synthetizes available data on clinical-pathological features and outcomes associated with IPMCs and their subtypes. We also describe known genomic hallmarks of these lesions and summarize the latest data about molecular processes involved in IPMNs initiation and progression to IPMCs. Finally, potential implications for clinical practice and future research strategies are discussed.

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The controversial role of adjuvant therapy in node negative invasive IPMN

Cited by 2 publications

References 0 publications

Adjuvant Chemotherapy in the Treatment of Intraductal Papillary Mucinous Neoplasms of the Pancreas: Systematic Review and Meta‐Analysis

Adjuvant Chemotherapy in the Treatment of Intraductal Papillary Mucinous Neoplasms of the Pancreas: Systematic Review and Meta‐Analysis

Intraductal Papillary Mucinous Carcinoma Versus Conventional Pancreatic Ductal Adenocarcinoma: A Comprehensive Review of Clinical-Pathological Features, Outcomes, and Molecular Insights

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