Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas

A matched control study with conventional pancreatic ductal adenocarcinoma

Adam C. Yopp, Nora Katabi, Maria Janakos, David S. Klimstra, Michael I. Dangelica, Ronald P. Dematteo, Yuman Fong, Murray F. Brennan, William R. Jarnagin, Peter J. Allen

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Abstract

Objective: The purpose of this study was to characterize the clinicopathological features of invasive carcinomas arising in intraductal papillary mucinous neoplasms of the pancreas (IPMN) by histological subtype of the invasive component and to compare the outcomes of these patients to a cohort of matched patients with conventional ductal pancreatic adenocarcinoma. Background: Two distinct histological subtypes of invasive carcinomas arising in IPMNs have been described, colloid carcinoma and tubular carcinoma. Previous reports have suggested prognostic differences between these 2 subtypes but a matched comparison of colloid carcinoma, tubular carcinoma, and conventional pancreatic adenocarcinoma has not been reported. Methods: The clinicopathological variables of 59 patients resected for an invasive component of IPMN were analyzed with detailed pathologic review of histopathologic subtype (colloid carcinoma and tubular carcinoma). Using a postresection pancreatic adenocarcinoma nomogram, patients with either tubular or colloid carcinoma were matched on a 1:1 basis with patients resected for conventional ductal pancreatic adenocarcinoma. Clinicopathological factors and overall outcome was analyzed between the matched groups. Results: Fifty-nine patients underwent resection for IPMN with an associated invasive carcinoma (IPMN-INV). The estimated 3- and 5-year survival rates were 76% and 68%, respectively. Tubular carcinoma was present in 35 patients (59%) and 24 patients (41%) had colloid carcinoma. Tubular carcinoma subtype [hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.2-11.6] and the presence of positive regional lymph nodes (HR 3.2 95% CI 1.2-8.2) were clinicopathological factors predictive of decreased survival by multivariate analysis. The 5-year estimated survival rates for tubular carcinoma and colloid carcinoma were 55% and 87%, respectively (P = 0.01). When compared with patients with conventional ductal pancreatic ductal adenocarcinoma resected during the same time period matched by a prognostic nomogram, patients with colloid carcinoma had a significantly longer survival outcome compared with patients with conventional adenocarcinoma (P = 0.0001). By contrast, survival after resection between patients with the tubular subtype (3-year estimated survival, 61%) and the matched group with conventional adenocarcinoma (3-year estimated survival, 21%) (P = 0.87) was not statistically different. Conclusions: In this study, the colloid carcinoma histological subtype of invasive IPMN had a more statistically favorable survival outcome than the tubular subtype. Patients with invasive tubular IPMN had no statistically significant difference in survival as matched patients with conventional ductal pancreatic carcinoma.

Original languageEnglish (US)
Pages (from-to)968-974
Number of pages7
JournalAnnals of Surgery
Volume253
Issue number5
DOIs
StatePublished - May 2011

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Pancreatic Neoplasms
Adenocarcinoma
Mucinous Adenocarcinoma
Carcinoma
Survival
Nomograms
Research Design
Survival Rate
Pancreatic Ductal Carcinoma
Confidence Intervals
Carcinoma, Intraductal, Noninfiltrating
Papillary Carcinoma
Survival Analysis
Multivariate Analysis
Lymph Nodes

ASJC Scopus subject areas

  • Surgery

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Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas : A matched control study with conventional pancreatic ductal adenocarcinoma. / Yopp, Adam C.; Katabi, Nora; Janakos, Maria; Klimstra, David S.; Dangelica, Michael I.; Dematteo, Ronald P.; Fong, Yuman; Brennan, Murray F.; Jarnagin, William R.; Allen, Peter J.

In: Annals of Surgery, Vol. 253, No. 5, 05.2011, p. 968-974.

Research output: Contribution to journalArticle

Yopp, AC, Katabi, N, Janakos, M, Klimstra, DS, Dangelica, MI, Dematteo, RP, Fong, Y, Brennan, MF, Jarnagin, WR & Allen, PJ 2011, 'Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas: A matched control study with conventional pancreatic ductal adenocarcinoma', Annals of Surgery, vol. 253, no. 5, pp. 968-974. https://doi.org/10.1097/SLA.0b013e318214bcb4
Yopp, Adam C. ; Katabi, Nora ; Janakos, Maria ; Klimstra, David S. ; Dangelica, Michael I. ; Dematteo, Ronald P. ; Fong, Yuman ; Brennan, Murray F. ; Jarnagin, William R. ; Allen, Peter J. / Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas : A matched control study with conventional pancreatic ductal adenocarcinoma. In: Annals of Surgery. 2011 ; Vol. 253, No. 5. pp. 968-974.
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title = "Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas: A matched control study with conventional pancreatic ductal adenocarcinoma",
abstract = "Objective: The purpose of this study was to characterize the clinicopathological features of invasive carcinomas arising in intraductal papillary mucinous neoplasms of the pancreas (IPMN) by histological subtype of the invasive component and to compare the outcomes of these patients to a cohort of matched patients with conventional ductal pancreatic adenocarcinoma. Background: Two distinct histological subtypes of invasive carcinomas arising in IPMNs have been described, colloid carcinoma and tubular carcinoma. Previous reports have suggested prognostic differences between these 2 subtypes but a matched comparison of colloid carcinoma, tubular carcinoma, and conventional pancreatic adenocarcinoma has not been reported. Methods: The clinicopathological variables of 59 patients resected for an invasive component of IPMN were analyzed with detailed pathologic review of histopathologic subtype (colloid carcinoma and tubular carcinoma). Using a postresection pancreatic adenocarcinoma nomogram, patients with either tubular or colloid carcinoma were matched on a 1:1 basis with patients resected for conventional ductal pancreatic adenocarcinoma. Clinicopathological factors and overall outcome was analyzed between the matched groups. Results: Fifty-nine patients underwent resection for IPMN with an associated invasive carcinoma (IPMN-INV). The estimated 3- and 5-year survival rates were 76{\%} and 68{\%}, respectively. Tubular carcinoma was present in 35 patients (59{\%}) and 24 patients (41{\%}) had colloid carcinoma. Tubular carcinoma subtype [hazard ratio (HR) 3.7, 95{\%} confidence interval (CI) 1.2-11.6] and the presence of positive regional lymph nodes (HR 3.2 95{\%} CI 1.2-8.2) were clinicopathological factors predictive of decreased survival by multivariate analysis. The 5-year estimated survival rates for tubular carcinoma and colloid carcinoma were 55{\%} and 87{\%}, respectively (P = 0.01). When compared with patients with conventional ductal pancreatic ductal adenocarcinoma resected during the same time period matched by a prognostic nomogram, patients with colloid carcinoma had a significantly longer survival outcome compared with patients with conventional adenocarcinoma (P = 0.0001). By contrast, survival after resection between patients with the tubular subtype (3-year estimated survival, 61{\%}) and the matched group with conventional adenocarcinoma (3-year estimated survival, 21{\%}) (P = 0.87) was not statistically different. Conclusions: In this study, the colloid carcinoma histological subtype of invasive IPMN had a more statistically favorable survival outcome than the tubular subtype. Patients with invasive tubular IPMN had no statistically significant difference in survival as matched patients with conventional ductal pancreatic carcinoma.",
author = "Yopp, {Adam C.} and Nora Katabi and Maria Janakos and Klimstra, {David S.} and Dangelica, {Michael I.} and Dematteo, {Ronald P.} and Yuman Fong and Brennan, {Murray F.} and Jarnagin, {William R.} and Allen, {Peter J.}",
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T1 - Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas

T2 - A matched control study with conventional pancreatic ductal adenocarcinoma

AU - Yopp, Adam C.

AU - Katabi, Nora

AU - Janakos, Maria

AU - Klimstra, David S.

AU - Dangelica, Michael I.

AU - Dematteo, Ronald P.

AU - Fong, Yuman

AU - Brennan, Murray F.

AU - Jarnagin, William R.

AU - Allen, Peter J.

PY - 2011/5

Y1 - 2011/5

N2 - Objective: The purpose of this study was to characterize the clinicopathological features of invasive carcinomas arising in intraductal papillary mucinous neoplasms of the pancreas (IPMN) by histological subtype of the invasive component and to compare the outcomes of these patients to a cohort of matched patients with conventional ductal pancreatic adenocarcinoma. Background: Two distinct histological subtypes of invasive carcinomas arising in IPMNs have been described, colloid carcinoma and tubular carcinoma. Previous reports have suggested prognostic differences between these 2 subtypes but a matched comparison of colloid carcinoma, tubular carcinoma, and conventional pancreatic adenocarcinoma has not been reported. Methods: The clinicopathological variables of 59 patients resected for an invasive component of IPMN were analyzed with detailed pathologic review of histopathologic subtype (colloid carcinoma and tubular carcinoma). Using a postresection pancreatic adenocarcinoma nomogram, patients with either tubular or colloid carcinoma were matched on a 1:1 basis with patients resected for conventional ductal pancreatic adenocarcinoma. Clinicopathological factors and overall outcome was analyzed between the matched groups. Results: Fifty-nine patients underwent resection for IPMN with an associated invasive carcinoma (IPMN-INV). The estimated 3- and 5-year survival rates were 76% and 68%, respectively. Tubular carcinoma was present in 35 patients (59%) and 24 patients (41%) had colloid carcinoma. Tubular carcinoma subtype [hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.2-11.6] and the presence of positive regional lymph nodes (HR 3.2 95% CI 1.2-8.2) were clinicopathological factors predictive of decreased survival by multivariate analysis. The 5-year estimated survival rates for tubular carcinoma and colloid carcinoma were 55% and 87%, respectively (P = 0.01). When compared with patients with conventional ductal pancreatic ductal adenocarcinoma resected during the same time period matched by a prognostic nomogram, patients with colloid carcinoma had a significantly longer survival outcome compared with patients with conventional adenocarcinoma (P = 0.0001). By contrast, survival after resection between patients with the tubular subtype (3-year estimated survival, 61%) and the matched group with conventional adenocarcinoma (3-year estimated survival, 21%) (P = 0.87) was not statistically different. Conclusions: In this study, the colloid carcinoma histological subtype of invasive IPMN had a more statistically favorable survival outcome than the tubular subtype. Patients with invasive tubular IPMN had no statistically significant difference in survival as matched patients with conventional ductal pancreatic carcinoma.

AB - Objective: The purpose of this study was to characterize the clinicopathological features of invasive carcinomas arising in intraductal papillary mucinous neoplasms of the pancreas (IPMN) by histological subtype of the invasive component and to compare the outcomes of these patients to a cohort of matched patients with conventional ductal pancreatic adenocarcinoma. Background: Two distinct histological subtypes of invasive carcinomas arising in IPMNs have been described, colloid carcinoma and tubular carcinoma. Previous reports have suggested prognostic differences between these 2 subtypes but a matched comparison of colloid carcinoma, tubular carcinoma, and conventional pancreatic adenocarcinoma has not been reported. Methods: The clinicopathological variables of 59 patients resected for an invasive component of IPMN were analyzed with detailed pathologic review of histopathologic subtype (colloid carcinoma and tubular carcinoma). Using a postresection pancreatic adenocarcinoma nomogram, patients with either tubular or colloid carcinoma were matched on a 1:1 basis with patients resected for conventional ductal pancreatic adenocarcinoma. Clinicopathological factors and overall outcome was analyzed between the matched groups. Results: Fifty-nine patients underwent resection for IPMN with an associated invasive carcinoma (IPMN-INV). The estimated 3- and 5-year survival rates were 76% and 68%, respectively. Tubular carcinoma was present in 35 patients (59%) and 24 patients (41%) had colloid carcinoma. Tubular carcinoma subtype [hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.2-11.6] and the presence of positive regional lymph nodes (HR 3.2 95% CI 1.2-8.2) were clinicopathological factors predictive of decreased survival by multivariate analysis. The 5-year estimated survival rates for tubular carcinoma and colloid carcinoma were 55% and 87%, respectively (P = 0.01). When compared with patients with conventional ductal pancreatic ductal adenocarcinoma resected during the same time period matched by a prognostic nomogram, patients with colloid carcinoma had a significantly longer survival outcome compared with patients with conventional adenocarcinoma (P = 0.0001). By contrast, survival after resection between patients with the tubular subtype (3-year estimated survival, 61%) and the matched group with conventional adenocarcinoma (3-year estimated survival, 21%) (P = 0.87) was not statistically different. Conclusions: In this study, the colloid carcinoma histological subtype of invasive IPMN had a more statistically favorable survival outcome than the tubular subtype. Patients with invasive tubular IPMN had no statistically significant difference in survival as matched patients with conventional ductal pancreatic carcinoma.

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