ASO Author Reflections: Which Patients with Invasive Intraductal Papillary Mucinous Neoplasm Can Benefit from Adjuvant T
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Which Patients with Invasive Intraductal Papillary Mucinous Neoplasm Can Benefit from Adjuvant Therapy? Chiara Croce, MD, PhD1, Benedetto Mungo, MD1, Atsushi Oba, MD, PhD1,2, Richard D. Schulick, MD, MBA, FACS1,3, and Marco Del Chiaro, MD, PhD, FACS1,3 1
Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan; 3University of Colorado Cancer Center, Denver, CO 2
PAST Surgical treatment is traditionally considered the standard of care for invasive intraductal papillary mucinous neoplasm (IIPMN); however, differently from the classic pancreatic ductal adenocarcinoma (PDAC) where adjuvant chemo(radiation) therapy represents the gold standard, for IIPMN the decision to administer adjuvant treatment is more controversial and traditionally extrapolated from data regarding PDAC, since most literature specific to this topic is represented by small and underpowered studies.1,2 The rationale of this study derives from the need to add scientific evidence to the therapeutic management of patients undergoing pancreatic resection for IIPMN. PRESENT This study compares two groups of patients [out of a total of 492 patients whose data were collected from the National Cancer Database (NCDB)] undergoing curativeintent pancreatic resection for IIPMN, who did or did not receive adjuvant treatment. The characteristics of the two groups were compared by a propensity score model to address the inherent selection biases. After median followup of 57.3 months, we found that N0 status per se
Ó Society of Surgical Oncology 2020 First Received: 13 July 2020 Accepted: 20 July 2020 M. Del Chiaro, MD, PhD, FACS e-mail: [email protected]
conferred a statistically significant advantage in overall survival (OS) (median survival time 99.5 months in N0 patients versus 19.9 months in N1 patients). Interestingly, when comparing patients who received postoperative treatment with those who did not, we found a significant survival benefit only in the N1 category; thus we concluded that adjuvant treatment remains the gold standard for IIPMN patients with metastatic nodal disease. While this can be administered to node-negative patients with a more selective approach, that takes in account the potential impact of toxicity and side effects of chemotherapy for any given patient.3 FUTURE This study has several limitations related mainly to its retrospective nature. However, we can conclude that it further reinforces the existing evidence of a survival benefit of adjuvant therapy for patients undergoing pancreatic resection for IIPMN with positive nodes. As for N0 patients, this study supports a more cautious and judicious selection of patients that balances a potential oncologic benefit with toxicity and side effects of chemotherapy. In the future, we would need ideally to conduct prospective studies on
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