IMPACT OF ADJUVANT TREATMENT FOLLOWING SURGERY FOR INVASIVE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM OF THE PANCREAS
Clifton Rodrigues*, Debora Ciprani, Thomas P. Hank, Maximilian Weniger, Motaz Qadan, Cristina R. Ferrone, Andrew L. Warshaw, Keith D. Lillemoe, Carlos Fernandez-Del Castillo
Surgery, Massachusetts General Hospital, Boston, India
Introduction
There is limited data on the utility of adjuvant therapy in invasive IPMN. The aim of this study is to assess the patterns of use of chemotherapy and radiotherapy following surgery for invasive IPMN and its impact on overall survival.
Methods
From a prospectively maintained database at the Massachusetts General Hospital, patients who underwent surgery for invasive IPMN cancer between 1993 and 2018 were included in the study. Data were collected on demographics, comorbidities, type of surgery and pathological characteristics, and compared between patients with and without adjuvant treatment. We evaluated overall survival (OS) using multivariate Cox regression adjusting for age, type of invasive IPMN, tumor and nodal stage.
Results
110 patients with invasive IPMN were identified; of which 69 were tubular, 35 colloid and 6 oncocytic. 64 patients underwent surgery alone and 46 underwent surgery followed by adjuvant therapy; of the latter, 13 received chemotherapy alone, 25 chemotherapy and radiation and 8 patients only radiation. Patients who received adjuvant treatment were significantly younger (median: 61.5 vs 74 years; p < 0.001), had higher T stage (p= 0.03) and N stage (p= 0.02). Median follow up was 40 months (3.4 - 274 months). Unadjusted median overall survival was 155 months for the surgery alone group and 50.5 months in the adjuvant therapy group, with 5-year OS of 67.8% and 40%, respectively, p=0.001. Following adjustment for age, invasive type, T and N stage, survival was no longer significantly different between the adjuvant and surgery alone groups, HR of adjuvant therapy 1.575 (0.815-3.034), p= 0.176, with a 5-year survival of 66% vs 51 % in the surgery only and adjuvant therapy group, respectively. N1 and N2 nodal stage and T2 tumor stage were significant predictors of a poor overall survival: N1 vs N0, HR=3.25 (1.61-6.55), p=0.001. N2 vs N0, HR= 5.88 (2.45-14.14), p=0.0001. T2 vs T1 HR=2.598 (1.312-5.143), p=0.006.
Conclusion
Patients with invasive IPMN that received adjuvant therapy were younger and had an advanced tumor and nodal stage. However, adjuvant treatment did not appear to significantly influence overall survival. The only significant predictors of poor survival following resection were tumor size and nodal metastasis.
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