Minimally invasive intraductal papillary-mucinous carcinoma of the pancreas: clinicopathologic study of 104 intraductal papillary-mucinous neoplasms.
Invasive intraductal papillary-mucinous carcinoma (I-IPMC) is a heterogeneous entity with various postoperative outcomes. The aim of this study is to characterize early-stage I-IPMC with nonaggressive characteristics. One hundred and four patients with intraductal papillary-mucinous neoplasm (IPMN) were clinicopathologically investigated. The lesions were classified into 53 noninvasive IPMNs (adenoma, borderline, and noninvasive IPMC) and 51 I-IPMCs on the basis of the WHO classification. I-IPMCs were divided further into 26 minimally invasive IPMCs (MI-IPMCs) and 25 invasive carcinomas originating in IPMC (IC-IPMCs) by new diagnostic criteria proposed in this study. We examined invasiveness of I-IPMC on 4 patterns, and defined simple and practical diagnostic criteria of minimal invasion for each invasive pattern. The disease-specific survival rates after 3, 5, and 10 years were 100%, 100%, and 100% for both noninvasive IPMN and MI-IPMC, and 51%, 38%, and 0% for IC-IPMC. The overall and disease-specific survival rates for MI-IPMC were both significantly better than those for IC-IPMC (P<0.001), but there was no significant difference between noninvasive IPMN and MI-IPMC. Multivariate analysis showed that the factors indicative of poor prognosis were a diagnosis of I-IPMC classified as IC-IPMC and a high level of serum carbohydrate antigen 19-9. The prognosis of IC-IPMC was not significantly different from that of pancreatic ductal carcinoma in each of the corresponding tumor-node-metastasis stages. These findings suggest that a category of MI-IPMC provides more accurate and useful information of the stage and the aggressiveness of I-IPMC.
Nara
Satoshi
S
Pathology Division, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan.
Shimada
Kazuaki
K
Kosuge
Tomoo
T
Kanai
Yae
Y
Hiraoka
Nobuyoshi
N
D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000236:Adenoma / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate