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Pancreas
Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes
  1. Mari Mino-Kenudson1,
  2. Carlos Fernández-del Castillo2,
  3. Yoshifumi Baba3,
  4. Nakul P Valsangkar2,
  5. Andrew S Liss2,
  6. Maylee Hsu1,
  7. Camilo Correa-Gallego2,
  8. Thun Ingkakul2,
  9. Rocio Perez Johnston4,
  10. Brian G Turner5,
  11. Vasiliki Androutsopoulos2,
  12. Vikram Deshpande1,
  13. Deborah McGrath2,
  14. Dushyant V Sahani4,
  15. William R Brugge5,
  16. Shuji Ogino3,6,
  17. Martha B Pitman1,
  18. Andrew L Warshaw2,
  19. Sarah P Thayer2
  1. 1Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
  4. 4Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  5. 5Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  6. 6Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Mari Mino-Kenudson, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Warren 122, Boston, MA 02114, USA; mminokenudson{at}partners.org

Abstract

Objective Invasive cancers arising from intraductal papillary mucinous neoplasm (IPMN) are recognised as a morphologically and biologically heterogeneous group of neoplasms. Less is known about the epithelial subtypes of the precursor IPMN from which these lesions arise. The authors investigate the clinicopathological characteristics and the impact on survival of both the invasive component and its background IPMN.

Design and patients The study cohort comprised 61 patients with invasive IPMN (study group) and 570 patients with pancreatic ductal adenocarcinoma (PDAC, control group) resected at a single institution. Multivariate analyses were performed using a stage-matched Cox proportional hazard model.

Results The histology of invasive components of the IPMN cohort was tubular in 38 (62%), colloid in 16 (26%), and oncocytic in seven (12%). Compared with PDAC, invasive IPMNs were associated with a lower incidence of adverse pathological features and improved mortality by multivariate analysis (HR 0.58; 95% CI 0.39 to 0.86). In subtype analysis, this favourable outcome remained only for colloid and oncocytic carcinomas, while tubular adenocarcinoma was associated with worse overall survival, not significantly different from that of PDAC (HR 0.85; 95% CI 0.53 to 1.36). Colloid and oncocytic carcinomas arose only from intestinal- and oncocytic-type IPMNs, respectively, and were mostly of the main-duct type, whereas tubular adenocarcinomas primarily originated in the gastric background, which was often associated with branch-duct IPMN. Overall survival of patients with invasive adenocarcinomas arising from gastric-type IPMN was significantly worse than that of patients with non-gastric-type IPMN (p=0.016).

Conclusions Tubular, colloid and oncocytic invasive IPMNs have varying prognosis, and arise from different epithelial subtypes. Colloid and oncocytic types have markedly improved biology, whereas the tubular type has a course that resembles PDAC. Analysis of these subtypes indicates that the background epithelium plays an equally, if not more, important role in defining the biology and prognosis of invasive IPMNs.

  • IPMN
  • invasive adenocarcinoma
  • histologic subtypes
  • epithelial subtypes
  • outcome
  • histopathology
  • pancreatic cancer
  • surgical oncology

https://doi.org/10.1136/gut.2010.232272

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    Footnotes

    • Competing interests None.

    • Ethics approval This study was conducted with the approval of the Partners Human Research Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.