Invasive intraductal oncocytic papillary neoplasms (IOPN) and adenocarcimoma arising from intraductal papillary mucinous neoplasms (A-IPMN) of the pancreas: comparative analysis of clinicopathological features, patterns of recurrence and survival: a multicentre study.
Lucocq J., Haugk B., Joseph N., Hawkyard J., White S., Mownah O., Menon K., Furukawa T., Inoue Y., Hirose Y., Sasahira N., Mittal A., Samra J., Sheen A., Feretis M., Balakrishnan A., Ceresa C., Davidson B., Pande R., Dasari BVM., Tanno L., Karavias D., Helliwell J., Young A., Nunes Q., Urbonas T., Silva M., Gordon-Weeks A., Barrie J., Gomez D., van Laarhoven S., Nawara H., Doyle J., Bhogal R., Harrison E., Roalso M., Zaharia C., Ciprani D., Aroori S., Ratnayake B., Koea J., Capurso G., Bellotti R., Stättner S., Alsaoudi T., Bhardwaj N., Jeffery F., Connor S., Cameron A., Jamieson N., Roberts K., Soreide K., Gill AJ., Pandanaboyana S.
BACKGROUND: Intraductal oncocytic papillary neoplasms (IOPNs) of the pancreas are now considered a separate entity to intraductal papillary mucinous neoplasms (IPMN). Invasive IOPNs are extremely rare, and their recurrence patterns, response to adjuvant chemotherapy and long-term survival outcomes are unknown. METHODS: Consecutive patients undergoing pancreatic resection (2010-2020) for invasive IOPNs or adenocarcinoma arising from IPMN (A-IPMN) from 18 academic pancreatic centers worldwide were included. Outcomes of invasive IOPNs were compared with A-IPMN invasive subtypes (ductal and colloid A-IPMN). RESULTS: 415 patients were included: 20 invasive IOPN, 331 ductal A-IPMN and 64 colloid A-IPMN. After a median follow-up of 6-years, 45% and 60% of invasive IOPNs had developed recurrence and died, respectively. There was no significant difference in recurrence or overall survival between invasive IOPN and ductal A-IPMN. Overall survival of invasive IOPNs was inferior to colloid A-IPMNs (median time of survival 24.4 months vs. 86.7, months, p = 0.013), but the difference in recurrence only showed borderline significance (median time to recurrence, 22.5 months vs. 78.5 months, p = 0.132). Adjuvant chemotherapy, after accounting for high-risk features, did not reduce rates of recurrence in invasive IOPN (p = 0.443), ductal carcinoma (p = 0.192) or colloid carcinoma (p = 0.574). CONCLUSIONS: Invasive IOPNs should be considered an aggressive cancer with a recurrence rate and prognosis consistent with ductal type A-IPMN.