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An international multi-institutional validation of T1 sub-staging of intraductal papillary mucinous neoplasm-derived pancreatic cancer

Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) is resected at smaller sizes compared with its biologically distinct counterpart, pancreatic intraepithelial neoplasia (PanIN)-derived PDAC. Thus, experts proposed T1 sub-staging for IPMN-derived PDAC. How...

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Main Authors: Habib, Joseph (Author) , Rompen, Ingmar F. (Author) , Campbell, Brady A. (Author) , Andel, Paul C. M. (Author) , Kinny-Köster, Benedict (Author) , Damaseviciute, Ryte (Author) , Brock Hewitt, D. (Author) , Sacks, Greg D. (Author) , Javed, Ammar A. (Author) , Besselink, Marc G. (Author) , van Santvoort, Hjalmar C. (Author) , Daamen, Lois A. (Author) , Loos, Martin (Author) , He, Jin (Author) , Quintus Molenaar, I. (Author) , Büchler, Markus W. (Author) , Wolfgang, Christopher L. (Author)
Format: Article (Journal)
Language:English
Published: November 2024
In: Journal of the National Cancer Institute
Year: 2024, Volume: 116, Issue: 11, Pages: 1791-1797
ISSN:1460-2105
DOI:10.1093/jnci/djae166
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/jnci/djae166
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Author Notes:Joseph R. Habib, Ingmar F. Rompen, Brady A. Campbell, Paul C.M. Andel, Benedict Kinny-Köster, Ryte Damaseviciute, D. Brock Hewitt, Greg D. Sacks, Ammar A .Javed, Marc G. Besselink, Hjalmar C. van Santvoort, Lois A. Daamen, Martin Loos, Jin He, I. Quintus Molenaar, Markus W. Büchler, Christopher L . Wolfgang
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Summary:Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) is resected at smaller sizes compared with its biologically distinct counterpart, pancreatic intraepithelial neoplasia (PanIN)-derived PDAC. Thus, experts proposed T1 sub-staging for IPMN-derived PDAC. However, this has never been validated.Consecutive upfront surgery patients with IPMN-derived PDAC from 5 international high-volume centers were classified by the proposed T1 sub-staging classification (T1a ≤0.5, T1b >0.5 and ≤1.0, and T1c >1.0 and ≤2.0 cm) using the invasive component size. Kaplan-Meier and log-rank tests were used to compare overall survival (OS). A multivariable Cox regression was used to determine hazard ratios (HRs) with confidence intervals (95% CIs).Among 747 patients, 69 (9.2%), 50 (6.7%), 99 (13.0%), and 531 patients (71.1%), comprised the T1a, T1b, T1c, and T2-4 subgroups, respectively. Increasing T-stage was associated with elevated CA19-9, poorer grade, nodal positivity, R1 margin, and tubular subtype. Median OS for T1a, T1b, T1c, and T2-4 were 159.0 (95% CI = 126.0 to NR), 128.8 (98.3 to NR), 77.6 (48.3 to 108.2), and 31.4 (27.5 to 37.7) months, respectively (P < .001). OS decreased with increasing T-stage for all pairwise comparisons (all P < .05). After risk adjustment, older than age 65, elevated CA19-9, T1b [HR = 2.55 (1.22 to 5.32)], T1c [HR = 3.04 (1.60 to 5.76)], and T2-4 [HR = 3.41 (1.89 to 6.17)] compared with T1a, nodal positivity, R1 margin, and no adjuvant chemotherapy were associated with worse OS. Disease recurrence was more common in T2-4 tumors (56.4%) compared with T1a (18.2%), T1b (23.9%), and T1c (36.1%, P < .001).T1 sub-staging of IPMN-derived PDAC is valid and has significant prognostic value. Advancing T1 sub-stage is associated with worse histopathology, survival, and recurrence. T1 sub-staging is recommended for future guidelines.
Item Description:Online veröffentlicht: 19. Juli 2024
Gesehen am 18.08.2025
Physical Description:Online Resource
ISSN:1460-2105
DOI:10.1093/jnci/djae166

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