Background: Intraductal papillary mucinous neoplasms (IPMNs) are premalignant cystic neoplasms of the pancreas (CNPs), which can progress to invasive IPMN and pancreatic cancer. The available literature has shown controversial results regarding prognosis and clinical outcomes after the resection of invasive IPMN. Aims: This study aims to characterize the oncologic outcomes and metastatic progression pattern after the resection of non-metastatic invasive IPMN. Methods: Data were obtained from 24 clinical cancer registries participating in the German Cancer Registry Group of the Society of German Tumor Centers (ADT). Patients with invasive IPMN (n= 217) as well as PDAC (n= 5794) between 2000 and 2021 were included and compared regarding oncological outcomes. Results: Invasive IPMN was significantly smaller in size (p< 0.001) and of a lower tumor grade (p< 0.001), with fewer lymph node metastases (p< 0.001), lymphangiosis (p< 0.001), and consequently a higher R0 resection rate (88 vs. 74%) compared to PDAC. Moreover, invasive IPMN was associated with fewer local (11 vs. 15%) and distant recurrences (29 vs. 46%) and metastasized more frequently in the lungs only (26% vs. 14%). Invasive IPMN was associated with a longer median OS (29 vs. 19 months) and DFS (31 vs. 15 months) compared to PDAC and stayed independently prognostic in multivariable analyses. These survival differences were most pronounced in early tumor stages. Interestingly, postoperative chemotherapy was not associated with improved overall survival in surgically resected invasive IPMN. Conclusions: Invasive IPMN is a rare pancreatic entity with increasing incidence in Germany. It is associated with favorable histopathological features at the time of resection and longer OS and DFS compared to PDAC, particularly before the locoregional spread has occurred. Invasive IPMNs are associated with lung-only metastasis. The benefit of postoperative chemotherapy after the resection of invasive IPMN remains uncertain.
背景：导管内乳头状黏液性肿瘤（IPMN）是胰腺的癌前囊性肿瘤，可能进展为浸润性IPMN和胰腺癌。现有文献关于浸润性IPMN切除后的预后和临床结局存在争议。目的：本研究旨在明确非转移性浸润性IPMN切除后的肿瘤学结局及转移进展模式。方法：数据来源于参与德国肿瘤中心协会癌症登记组的24个临床癌症登记处。研究纳入了2000年至2021年间确诊的浸润性IPMN患者（n=217）和胰腺导管腺癌（PDAC）患者（n=5794），并比较其肿瘤学结局。结果：与PDAC相比，浸润性IPMN的肿瘤体积显著更小（p<0.001）、分级更低（p<0.001），淋巴结转移（p<0.001）和淋巴管浸润（p<0.001）更少，因此R0切除率更高（88% vs. 74%）。此外，浸润性IPMN的局部复发率（11% vs. 15%）和远处复发率（29% vs. 46%）更低，且更常仅发生肺转移（26% vs. 14%）。与PDAC相比，浸润性IPMN的中位总生存期（29 vs. 19个月）和无病生存期（31 vs. 15个月）更长，在多变量分析中仍保持独立预后价值。这些生存差异在早期肿瘤阶段最为显著。值得注意的是，术后化疗与手术切除的浸润性IPMN患者总生存期的改善无关。结论：浸润性IPMN是一种罕见的胰腺肿瘤，在德国的发病率呈上升趋势。与PDAC相比，其在切除时具有更有利的组织病理学特征，总生存期和无病生存期更长，尤其在尚未发生局部区域扩散时。浸润性IPMN与单纯肺转移相关。浸润性IPMN切除后辅助化疗的获益仍不明确。
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