title: Pancreatic intraepithelial neoplasia in the background of invasive ductal carcinoma of the pancreas as a prognostic factor.
abstract: OBJECTIVE
  Of the recognized precursor lesions of pancreatic adenocarcinoma, pancreatic intraepithelial neoplasia (PanIN) is the most common form. However, little is known about the relationship between the grade of PanIN and prognosis for patients with invasive ductal carcinoma.
  
  
  RESULTS
  In 124 patients with invasive ductal carcinoma, we examined the grade and number of PanIN lesions in all slides of resected pancreas. The prevalence rates of PanIN-1A, PanIN-1B, PanIN-2 and PanIN-3 were 86%, 84%, 57% and 30%, respectively. We allocated PanIN-2 and PanIN-3 cases into a PanIN-high group, and cases showing PanIN-1A, PanIN-1B or absence of PanIN into a PanIN-low group. In clinicopathological analysis, PanIN-high status was significantly correlated with the number of PanIN lesions (P < 0.0001). Disease-free and overall survival were statistically better in the PanIN-high group than in the PanIN-low group (P = 0.0005 and P = 0.0003). Univariate and multivariate analyses revealed that tumour size and PanIN-low status were statistically significant factors for a poorer prognosis (P = 0.042 and P = 0.007).
  
  
  CONCLUSIONS
  In a pathological examination, it is important to evaluate the grade and number of PanINs in assessing the prognosis of pancreatic cancer.
authors.affiliation: Department of Anatomical Pathology, Kyushu University, Fukuoka, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Oda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aishima
authors.forename: Katsuya
authors.initials: K
authors.lastname: Morimatsu
authors.forename: Koji
authors.initials: K
authors.lastname: Shindo
authors.forename: Minoru
authors.initials: M
authors.lastname: Fujino
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Mizuuchi
authors.forename: Masami
authors.initials: M
authors.lastname: Hattori
authors.forename: Tetsuyuki
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
mesh_terms: D000368:Aged; D001284:Atrophy; D002278:Carcinoma in Situ / Q000473:pathology*; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000556:secondary; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011379:Prognosis
keywords: invasive ductal carcinoma; pancreas; pancreatic intraepithelial neoplasia; prognosis