Ann Surg Treat Res.  2018 May;94(5):247-253. 10.4174/astr.2018.94.5.247.

Clinical significance of pancreatic intraepithelial neoplasia in resectable pancreatic cancer on survivals

• Yu DY
• Yu YD
• Kim WB
• Han HJ
• Choi SB
• Kim DS
• Choi SY
• Kim JY
• Chang H
• Kim BH

• KMID: 2410268
• DOI: http://doi.org/10.4174/astr.2018.94.5.247

Abstract

PURPOSE
Noninvasive precursor lesions for pancreatic adenocarcinoma include pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm, and mucinous cystic neoplasm. PanIN is often found synchronously adjacent to resected pancreatic ductal adenocarcinoma (PDAC) tumors. However, its prognostic significance on outcome after PDAC resection is unknown. The purpose of the current study was to determine if the presence of PanIN has a prognostic or predictive effect on survival after resection for PDAC with curative intent.
METHODS
We retrospectively reviewed the clinicopathologic data of patients who underwent pancreatectomy for PDAC from January 2002 to January 2013. Intraductal papillary mucinous lesions and mucinous cystic neoplasms were excluded. All available postoperative imaging and clinical follow-up data were reviewed.
RESULTS
There were 95 patients who underwent pancreatectomy. Tumors were most commonly located in the pancreas head and as such pancreaticoduodenectomy was the most commonly performed operation. The median tumor size was 3.2 cm. An absence of PanIN lesions was identified in 39 patients (41%). Of the patients with PanIN lesions, high-grade PanIN (grade 3) was the most common type (64.3%) followed by grade 2 (28.6%). There was no significant difference in overall survival or disease-free survival between the non-PanIN and PanIN groups.
CONCLUSION
The presence or absence of PanIN lesions did not affect survival in patients undergoing resection for pancreatic cancer. However, patients with high-grade PanINs tended to have better overall survival. Larger studies with longer follow up are needed to accurately determine its clinical significance.

Keyword

Intraepithelial neoplasm; Pancreatic neoplasms; Survival

MeSH Terms

Adenocarcinoma
Carcinoma in Situ
Disease-Free Survival
Follow-Up Studies
Head
Humans
Mucins
Pancreas
Pancreatectomy
Pancreatic Ducts
Pancreatic Neoplasms*
Pancreaticoduodenectomy
Retrospective Studies
Mucins

Figure

• 

  Fig. 1 Histological features of pancreatic adenocarcinoma and pancreatic intraepithelial neoplasias (PanINs). PanINs are graded according to degrees of cellular atypia. Pancreatic adenocarcinoma without PanIN (non-PanIN) (A), PanIN 1 (B), PanIN 2 (C), and PanIN 3 (D). H&E stain, ×500.

• 

  Fig. 2 (A) Comparison of disease-free survival between the PanIN and non-PanIN group. Mean disease-free survival of PanIN group was 18.28 months (12.83–23.72 months) and of non-PanIN group was 17.34 months (11.34–23.44 months) (P = 0.648). (B) Comparison of disease-free survival between the higher-grade PanIN group (PanIN 2 and PanIN 3) and the lower-grade PanIN group (non-PanIN and PanIN 1). Mean disease-free survival of the higher-grade PanIN group was 18.0 months (range, 12.83–23.72 months) and of the lower grade PanIN group was 17.34 months (range, 11.34–23.44 months) (P = 0.885). PanIN, pancreatic intraepithelial neoplasia.

• 

  Fig. 3 (A) Comparison of overall survival between PanIN and non-PanIN group. Mean overall survival of PanIN group was 28.33 months (range, 22.33–34.32 months) and of non-PanIN group was 21.04 months (range, 15.34–26.75 months) (P = 0.067). (B) Comparison of overall survival between the higher-grade PanIN group (PanIN 2 and PanIN 3) and the lower-grade PanIN group (non-PanIN and PanIN 1). Mean overall survival of the higher-grade PanIN group was 29.01 months (range, 22.75–35.26 months) and of the lower-grade PanIN group was 20.62 months (range, 15.29–25.94 months) (P = 0.045). PanIN, pancreatic intraepithelial neoplasia.

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