TY - JOUR
T1 - High-grade pancreatic intraepithelial lesions
T2 - prevalence and implications in pancreatic neoplasia
AU - Park, Jean R.
AU - Li, Feng
AU - Oza, Veeral M.
AU - Sklaw, Brett C.
AU - Cronley, Kevin M.
AU - Wellner, Michael
AU - Swanson, Benjamin
AU - Krishna, Somashekar G.
N1 - Publisher Copyright:
© 2017 The Editorial Board of Hepatobiliary & Pancreatic Diseases International
PY - 2017/4/15
Y1 - 2017/4/15
N2 - Background High-grade pancreatic intraepithelial neoplasia (PanIN-3), a precursor of pancreatic ductal adenocarcinoma (PDAC), is not universally detected in resected pancreatic neoplasms. We sought to determine the prevalence and prognostic relevance of PanIN-3 lesions in primary surgical resections of PDACs and intraductal papillary mucinous neoplasms (IPMNs). Methods A retrospective review of a tertiary care center pathology database (1/2000-6/2014) was performed. Demographics, imaging, pathology, disease-recurrence, and survival data were reviewed. Results A total of 458 patients who underwent primary pancreatic resection were included. “PanIN-3” lesions were found in 74 (16.2%) patients who either had PDAC (n=67) or main duct (MD)-IPMN (n=7). Among IPMN-MDs, PanIN-3 lesions were exclusively found in those with pathological evidence of chronic pancreatitis. For PDACs, the median overall survival (OS) for pancreata with PanIN-3 lesions was significantly better than those without (OS 1.12 years, interquartile range [IQR] 0.72, 2.05 years vs OS 0.86 years, IQR 0.64, 1.60 years respectively; P=0.04). Multivariate Cox regression analysis demonstrated that the presence of PanIN-3 lesions was associated with a reduced risk of death (HR=0.43; 95% CI: 0.23-0.82; P =0.01). Conclusions Following primary resection of pancreatic adenocarcinoma, the lower survival observed in patients without PanIN-3 lesions might suggest a state of complete or accelerated transformation. Further investigations are necessary to validate these findings that might impact disease prognosis and management.
AB - Background High-grade pancreatic intraepithelial neoplasia (PanIN-3), a precursor of pancreatic ductal adenocarcinoma (PDAC), is not universally detected in resected pancreatic neoplasms. We sought to determine the prevalence and prognostic relevance of PanIN-3 lesions in primary surgical resections of PDACs and intraductal papillary mucinous neoplasms (IPMNs). Methods A retrospective review of a tertiary care center pathology database (1/2000-6/2014) was performed. Demographics, imaging, pathology, disease-recurrence, and survival data were reviewed. Results A total of 458 patients who underwent primary pancreatic resection were included. “PanIN-3” lesions were found in 74 (16.2%) patients who either had PDAC (n=67) or main duct (MD)-IPMN (n=7). Among IPMN-MDs, PanIN-3 lesions were exclusively found in those with pathological evidence of chronic pancreatitis. For PDACs, the median overall survival (OS) for pancreata with PanIN-3 lesions was significantly better than those without (OS 1.12 years, interquartile range [IQR] 0.72, 2.05 years vs OS 0.86 years, IQR 0.64, 1.60 years respectively; P=0.04). Multivariate Cox regression analysis demonstrated that the presence of PanIN-3 lesions was associated with a reduced risk of death (HR=0.43; 95% CI: 0.23-0.82; P =0.01). Conclusions Following primary resection of pancreatic adenocarcinoma, the lower survival observed in patients without PanIN-3 lesions might suggest a state of complete or accelerated transformation. Further investigations are necessary to validate these findings that might impact disease prognosis and management.
KW - intraductal papillary mucinous neoplasms
KW - pancreatic ductal adenocarcinoma
KW - pancreatic intraepithelial neoplasia
KW - pancreatic neoplasia
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U2 - 10.1016/S1499-3872(16)60186-8
DO - 10.1016/S1499-3872(16)60186-8
M3 - Article
C2 - 28381386
AN - SCOPUS:85017567286
SN - 1499-3872
VL - 16
SP - 202
EP - 208
JO - Hepatobiliary and Pancreatic Diseases International
JF - Hepatobiliary and Pancreatic Diseases International
IS - 2
ER -