Role of postoperative adjuvant therapy in resected invasive intraductal papillary mucinous neoplasm of the pancreas: A multicenter external validation

Munseok Choi, Jae Uk Chong, Ho Kyoung Hwang, Hyung Il Seo, Kwangho Yang, Je Ho Ryu, Younghoon Roh, Dong Hyun Kim, Jin Ho Lee, Woo Jung Lee, Sung Hoon Choi, Chang Moo Kang

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Abstract

Background: Adjuvant therapy is beneficial in prolonging survival in patients with pancreatic ductal adenocarcinoma (PDAC). However, no clear guidelines are available on the oncologic effect of adjuvant therapy in resected invasive intraductal papillary mucinous neoplasms (inv-IPMN). Methods: In total, 551 patients with PDAC and 67 patients with inv-IPMN of the pancreas were reviewed. For external validation, 46 patients with inv-IPMN from six other Korean institutions were enrolled. Propensity score-matched analysis and stage-matched survival analysis were conducted. Results: The mean follow-up durations in the inv-IPMN and PDAC groups were 43.36 months (SD, 42.34 months) and 43.35 months (SD, 35.62 months), respectively. The 5-year overall survival (OS) was significantly better in the resected inv-IPMN group than in the PDAC group in the overall stage-matched analysis (P <.001). In the inv-IPMN cohort, OS was better in the surgery alone group (P =.042). In subgroup analysis, no significant survival difference was found between the adjuvant therapy and surgery alone groups according to the stage (stage I; P =.285, stage II or III; P =.077). Multicenter external validation did not show a better OS in the adjuvant therapy group (P =.531). On multivariable analysis, only perineural invasion (PNI) was identified as an adverse prognostic factor in resected inv-IPMN (HR 4.844; 95% CI 1.696-13.838, P =.003). Conclusions: inv-IPMN has a more indolent course than PDAC. Current strategy of adjuvant therapy may not improve the OS in patients with resected inv-IPMN. Further investigations on the potential role of adjuvant therapy in inv-IPMN are mandatory.

Original languageEnglish
Pages (from-to)671-679
Number of pages9
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume28
Issue number8
DOIs
Publication statusPublished - 2021 Aug

Bibliographical note

Funding Information:
Acquired and analyzed the data and drafted the manuscript: Munseok Choi; analyzed and interpreted the data: Jae Uk Chong; acquired the data: Ho Kyoung Hwang, Hyung-Il Seo, Kwangho Yang, Je Ho Ryu, Younghoon Roh, Dong Hyun Kim, Jin Ho Lee, and Woo Jung Lee; revised the manuscript and agreed with the manuscript's results and conclusions: all the authors; supervised the study and gave final approval to the manuscript: Sung Hoon Choi and Chang Moo Kang

Publisher Copyright:
© 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hepatology

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