Adjuvant chemotherapy for adenocarcinoma arising from intraductal papillary mucinous neoplasia: multicentre ADENO-IPMN study
James Lucocq, Jake Hawkyard, Beate Haugk, Omar Mownah, Krishna Menon, Takaki Furukawa, Yosuke Inoue, Yuki Hirose, Naoki Sasahira, Michael Feretis, Anita Balakrishnan, Carlo Ceresa, Brian R Davidson, Rupaly Pandé, B. Dasari, Lulu Tanno, Dimitrios Karavias, Jack Helliwell, Alistair A. Young, Quentin Nunes, Tomas Urbonas, Michael Silva, Alex Gordon‐Weeks, Jenifer Barrie, Dhanny Gomez, Stijn van Laarhoven, Francis P. Robertson, Hossain Nawara, Joseph Doyle, Ricky H. Bhogal, Ewen M. Harrison, Marcus Roalsø, Debora Ciprani, Somaiah Aroori, Bathiya Ratnayake, Jonathan Koea, Gabriele Capurso, Ruben Bellotti, Stefan Stättner, Tareq Alsaoudi, Neil Bhardwaj, Srujan Rajesh, Fraser Jeffery, Saxon Connor, Andrew J. Cameron, Nigel B. Jamieson, Amy Sheen, Anubhav Mittal, Jas Samra, Anthony J. Gill, Keith Roberts, Kjetil Søreide, Sanjay Pandanaboyana
Abstract
BACKGROUND: The clinical impact of adjuvant chemotherapy after resection for adenocarcinoma arising from intraductal papillary mucinous neoplasia is unclear. The aim of this study was to identify factors related to receipt of adjuvant chemotherapy and its impact on recurrence and survival. METHODS: This was a multicentre retrospective study of patients undergoing pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasia between January 2010 and December 2020 at 18 centres. Recurrence and survival outcomes for patients who did and did not receive adjuvant chemotherapy were compared using propensity score matching. RESULTS: Of 459 patients who underwent pancreatic resection, 275 (59.9%) received adjuvant chemotherapy (gemcitabine 51.3%, gemcitabine-capecitabine 21.8%, FOLFIRINOX 8.0%, other 18.9%). Median follow-up was 78 months. The overall recurrence rate was 45.5% and the median time to recurrence was 33 months. In univariable analysis in the matched cohort, adjuvant chemotherapy was not associated with reduced overall (P = 0.713), locoregional (P = 0.283) or systemic (P = 0.592) recurrence, disease-free survival (P = 0.284) or overall survival (P = 0.455). Adjuvant chemotherapy was not associated with reduced site-specific recurrence. In multivariable analysis, there was no association between adjuvant chemotherapy and overall recurrence (HR 0.89, 95% c.i. 0.57 to 1.40), disease-free survival (HR 0.86, 0.59 to 1.30) or overall survival (HR 0.77, 0.50 to 1.20). Adjuvant chemotherapy was not associated with reduced recurrence in any high-risk subgroup (for example, lymph node-positive, higher AJCC stage, poor differentiation). No particular chemotherapy regimen resulted in superior outcomes. CONCLUSION: Chemotherapy following resection of adenocarcinoma arising from intraductal papillary mucinous neoplasia does not appear to influence recurrence rates, recurrence patterns or survival.