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Controversial Role of Adjuvant Therapy in Node-Negative Invasive Intraductal Papillary Mucinous Neoplasm

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Adjuvant chemotherapy and/or chemoradiation [chemo(radiation)] is considered the standard of care for resected patients with pancreatic adenocarcinoma. However, invasive carcinoma arising from an intraductal papillary mucinous neoplasm (IPMN) seems to have different biologic behavior and prognosis. Retrospective data suggest a survival benefit of adjuvant chemo(radiation) for resected invasive IPMNs with metastatic nodal disease; however, it is unclear whether this remains valid for node-negative patients.

Patients and Methods

To compare the outcome of patients with invasive IPMNs who received adjuvant chemo(radiation) with that of those treated with surgery alone, we queried the National Cancer Database regarding data of patients who underwent pancreatic resection for invasive IPMN between 2006 and 2015. A propensity score analysis was conducted to balance covariates between treatment groups.

Results

For the study, 492 patients were eligible, of whom 267 (54.3%) received adjuvant chemo(radiation). Estimated 1- and 3-year overall survival rates were 88.9% and 73.5% versus 93.2% and 72.8% for patients who did or did not receive adjuvant chemo(radiation), respectively. Among patients with negative nodal stage, there was no difference in overall survival between patients who received versus patients who did not receive adjuvant chemo(radiation) (P = 0.973). In contrast, among patients with positive nodal disease, those who received adjuvant chemo(radiation) had significantly better OS compared with those who did not (P = 0.001).

Conclusions

In patients with resected invasive IPMNs, adjuvant chemo(radiation) was associated with significantly improved overall survival only in presence of nodal metastases. This finding can help clinicians to select adjuvant treatment in a patient-tailored fashion.

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Author notes

  1. Benedetto Mungo and Chiara Croce have contributed equally to this paper.

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA

    Benedetto Mungo MD, Chiara Croce MD, PhD, Atsushi Oba MD, PhD, Steven Ahrendt MD, Ana Gleisner MD, PhD, Chloe Friedman MPH, Richard D. Schulick MD, MBA, FACS & Marco Del Chiaro MD, PhD, FACS

  2. Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan

    Atsushi Oba MD, PhD

  3. University of Colorado Cancer Center, Denver, CO, USA

    Steven Ahrendt MD, Ana Gleisner MD, PhD, Richard D. Schulick MD, MBA, FACS & Marco Del Chiaro MD, PhD, FACS

Authors
  1. Benedetto Mungo MD
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  2. Chiara Croce MD, PhD
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  3. Atsushi Oba MD, PhD
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  4. Steven Ahrendt MD
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  5. Ana Gleisner MD, PhD
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  7. Richard D. Schulick MD, MBA, FACS
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  8. Marco Del Chiaro MD, PhD, FACS
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Corresponding author

Correspondence to Marco Del Chiaro MD, PhD, FACS.

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Disclosures

We have been awarded an industry grant (Haemonetics, Inc) to conduct a multi-center study to evaluate the prognostic implications of TEG in pancreatic cancer. The corresponding author is a co-principal investigator of a Boston Scientific sponsored study on the use of intraoperative pancreatoscopy for main duct IPMNs.

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Mungo, B., Croce, C., Oba, A. et al. Controversial Role of Adjuvant Therapy in Node-Negative Invasive Intraductal Papillary Mucinous Neoplasm. Ann Surg Oncol 28, 1533–1542 (2021). https://doi.org/10.1245/s10434-020-08916-6

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  • DOI: https://doi.org/10.1245/s10434-020-08916-6

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