Is multidisciplinary treatment effective for invasive intraductal papillary mucinous carcinoma?

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2024-03-17 DOI:10.1002/ags3.12790

Seiko Hirono, Ryota Higuchi, Goro Honda, Satoshi Nara, Minoru Esaki, Naoto Gotohda, Hideki Takami, Michiaki Unno, Teiichi Sugiura, Masayuki Ohtsuka, Yasuhiro Shimizu, Ippei Matsumoto, Toshifumi Kin, Hiroyuki Isayama, Daisuke Hashimoto, Yasuji Seyama, Hiroaki Nagano, Kenichi Hakamada, Satoshi Hirano, Yuichi Nagakawa, Shugo Mizuno, Hidenori Takahashi, Kazuto Shibuya, Hideki Sasanuma, Taku Aoki, Yuichiro Kohara, Toshiki Rikiyama, Masafumi Nakamura, Itaru Endo, Yoshihiro Sakamoto, Akihiko Horiguchi, Takashi Hatori, Hirofumi Akita, Toshiharu Ueki, Tetsuya Idichi, Keiji Hanada, Shuji Suzuki, Keiichi Okano, Hiromitsu Maehira, Fuyuhiko Motoi, Yasuhiro Fujino, Satoshi Tanno, Akio Yanagisawa, Yoshifumi Takeyama, Kazuichi Okazaki, Sohei Satoi, Hiroki Yamaue

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Abstract

Background

Surgical resection is standard treatment for invasive intraductal papillary mucinous carcinoma (IPMC); however, impact of multidisciplinary treatment on survival including postoperative adjuvant therapy (AT), neoadjuvant therapy (NAT), and treatment for recurrent lesions is unclear. We investigated the effectiveness of multidisciplinary treatment in prolonging survival of patients with invasive IPMC.

Methods

This retrospective multi-institutional study included 1183 patients with invasive IPMC undergoing surgery at 40 academic institutions. We analyzed the effects of AT, NAT, and treatment for recurrence on survival of patients with invasive IPMC.

Results

Completion of the planned postoperative AT for 6 months improved the overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) of patients with stage IIB and stage III resected invasive IPMC, elevated preoperative carbohydrate antigen 19–9 level, lymphovascular invasion, perineural invasion, serosal invasion, and lymph node metastasis on un-matched and matched analyses. Of the patients with borderline resectable (BR) invasive IPMC, the OS (p = 0.001), DSS (p = 0.001), and RFS (p = 0.001) of patients undergoing NAT was longer than that of those without on the matched analysis. Of the 484 invasive IPMC patients (40.9%) who developed recurrence after surgery, the OS of 365 patients who received any treatment for recurrence was longer than that of those without treatment (40.6 vs. 22.4 months, p < 0.001).

Conclusion

Postoperative AT might benefit selected patients with invasive IPMC, especially those at high risk of poor survival. NAT might improve the survivability of BR invasive IPMC. Any treatment for recurrence after surgery for invasive IPMC might improve survival.

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多学科治疗对浸润性导管内乳头状黏液癌有效吗？

手术切除是浸润性导管内乳头状黏液癌（IPMC）的标准治疗方法；然而，包括术后辅助治疗（AT）、新辅助治疗（NAT）和复发病灶治疗在内的多学科治疗对生存期的影响尚不明确。我们研究了多学科治疗对延长侵袭性 IPMC 患者生存期的有效性。这项多机构回顾性研究纳入了在 40 家学术机构接受手术治疗的 1183 例侵袭性 IPMC 患者。我们分析了AT、NAT和复发治疗对浸润性IPMC患者生存期的影响。对 IIB 期和 III 期切除的浸润性 IPMC、术前碳水化合物抗原 19-9 水平升高、淋巴管侵犯、神经周围侵犯、浆膜侵犯和淋巴结转移的患者进行非匹配和匹配分析，结果显示，术后 6 个月完成计划的 AT 可提高患者的总生存率（OS）、疾病特异性生存率（DSS）和无复发生存率（RFS）。在边缘可切除（BR）浸润性 IPMC 患者中，接受 NAT 治疗的患者的 OS（p = 0.001）、DSS（p = 0.001）和 RFS（p = 0.001）均长于未接受 NAT 治疗的患者。在术后复发的 484 例浸润性 IPMC 患者（40.9%）中，365 例接受任何复发治疗的患者的 OS 比未接受治疗的患者长（40.6 个月对 22.4 个月，p < 0.001）。NAT可能会提高BR侵袭性IPMC的存活率。任何针对侵袭性 IPMC 术后复发的治疗方法都可能提高患者的生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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