High-grade pancreatic intraepithelial lesions: prevalence and implications in pancreatic neoplasia

• Published in: Hepatobiliary & pancreatic diseases international 2017-04, Vol.16 (2), p.202-208
• Main Authors: Park, Jean R, Li, Feng, Oza, Veeral M, Sklaw, Brett C, Cronley, Kevin M, Wellner, Michael, Swanson, Benjamin, Krishna, Somashekar G
• Format: Article
• Language: English
• Subjects: Adenocarcinoma, Papillary - mortality; Adenocarcinoma, Papillary - pathology; Adenocarcinoma, Papillary - surgery; Aged; Carcinoma in Situ - mortality; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Chi-Square Distribution; Databases, Factual; Endocrinology & Metabolism; Female; Gastroenterology and Hepatology; Humans; intraductal papillary mucinous neoplasms; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasms, Cystic, Mucinous, and Serous - mortality; Neoplasms, Cystic, Mucinous, and Serous - pathology; Neoplasms, Cystic, Mucinous, and Serous - surgery; Ohio; Pancreatectomy; pancreatic ductal adenocarcinoma; pancreatic intraepithelial neoplasia; pancreatic neoplasia; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Proportional Hazards Models; Retrospective Studies; Risk Factors; Tertiary Care Centers; Time Factors; Treatment Outcome
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(16)60186-8

Background High-grade pancreatic intraepithelial neoplasia (PanIN-3), a precursor of pancreatic ductal adenocarcinoma (PDAC), is not universally detected in resected pancreatic neoplasms. We sought to determine the prevalence and prognostic relevance of PanIN-3 lesions in primary surgical resections of PDACs and intraductal papillary mucinous neoplasms (IPMNs). Methods A retrospective review of a tertiary care center pathology database (1/2000-6/2014) was performed. Demographics, imaging, pathology, disease-recurrence, and survival data were reviewed. Results A total of 458 patients who underwent primary pancreatic resection were included. “PanIN-3” lesions were found in 74 (16.2%) patients who either had PDAC ( n =67) or main duct (MD)-IPMN ( n =7). Among IPMN-MDs, PanIN-3 lesions were exclusively found in those with pathological evidence of chronic pancreatitis. For PDACs, the median overall survival (OS) for pancreata with PanIN-3 lesions was significantly better than those without (OS 1.12 years, interquartile range [IQR] 0.72, 2.05 years vs OS 0.86 years, IQR 0.64, 1.60 years respectively; P =0.04). Multivariate Cox regression analysis demonstrated that the presence of PanIN-3 lesions was associated with a reduced risk of death (HR=0.43; 95% CI: 0.23-0.82; P =0.01). Conclusions Following primary resection of pancreatic adenocarcinoma, the lower survival observed in patients without PanIN-3 lesions might suggest a state of complete or accelerated transformation. Further investigations are necessary to validate these findings that might impact disease prognosis and management.