Comparison of clinical outcomes of type 1 intraductal papillary neoplasm of bile duct versus type 2 intraductal papillary neoplasm of bile duct after surgical resection = 1형 담관내 유두상 종양과 2형 담관내 유두상 종양의 수술적 치료 이후 예후비교에 대한 연구|RISS 상세보기

다국어 초록 (Multilingual Abstract)

Recently, the proposal of the Korea-Japan consensus meeting to classify intraductal papillary neoplasm of bile duct (IPNB) into type 1 IPNB and type 2 IPNB was reflected in 5th edition of the WHO. However, there is little investigation of oncologic outcomes according to type of invasive IPNB, which has the potential to cause recurrence. The purpose of this study is to find out whether there are differences in clinicopathological characteristics and oncological outcomes between subgroups (invasive type 1 IPNB and invasive type 2 IPNB).
From 2006 to 2018, consecutive 85 patients who were underwent surgical resection for IPNB and 1038 patients who were underwent surgical resection for nonpapillary CCC were prospectively collected and retrospectively reviewed. Using propensity score matching (PSM), 85 patients with matched nonpapillary CCCs were selected as a reference for the analysis of clinical characteristics for IPNB at a ratio of 1:1. Matching variables were age, sex, depth of invasion, lymph node metastasis, lymphovascular invasion (LVI), and perineural invasion (PNI). Type 1 IPNB was defined as IPNB with a well-organized papillary growth pattern and composed of a homogenous, regular lining epithelium and thin fibrovascular stalk. Type 2 IPNB was defined as IPNB with an irregular branching growth pattern and consisting of complex, irregular lining epithelium and thin to thick fibrovascular stalk.
Among the total 85 cases of IPNB, there were 36 cases of invasive type 1 IPNB and 34 cases of invasive type 2 IPNB. A significantly higher CA 19-9 level and a higher rate of LVI and pancreatobiliary phenotype were found in invasive type 2 IPNB compared to invasive type 1 IPNB (45.3 ± 122.5 U/ml vs 290.9 ± 760.0 U/ml, p = 0.028; 0 % vs 20.6 %, p = 0.004 and 13.9 % vs 58.8 %, p < 0.001). Immunohistochemistry (IHC) test showed that invasive type 2 IPNB had a significantly higher proportion of MUC1 than invasive type 1 IPNB (15.4 % VS 53.3%, p = 0.015). Marginally significant difference in 5-year DFS was observed between the invasive type 1 IPNB and invasive type 2 IPNB (86.1 % vs 66.0 %, p = 0.085). In a multivariate analysis, the risk factor affecting recurrence were CA 19-9≥14 U/ml (HR: 4.841, 95% CI 1.570 – 14.925, p = 0.006) and invasion beyond ductal wall (HR: 5.462, 95% CI 1.927 – 15.483, p = 0.001). The late recurrence rates between the two groups showed marginally significant differences (20.0 % vs 72.7 %, p = 0.094).
Conclusively, there was marginally significant difference in 5-year DFS between invasive type 1 IPNB and invasive type 2 IPNB. Variables that may affect poor prognosis (CA 19-9, LVI, pancreatobiliary phenotype, MUC1) appeared at a significantly higher rate in invasive type 2 IPNB than in invasive type 1 IPNB. Late recurrence occurred more frequently with marginally significance in invasive type 2 IPNB than in invasive type 1 IPNB. Given these, it seems necessary to apply different follow-up duration and strategies depending on the type of IPNB.

번역하기

목차 (Table of Contents)

ABSTRACT 1
I. Introduction 3
II. Methods 5
III. Results 8
IV. Discussion 13

ABSTRACT 1
I. Introduction 3
II. Methods 5
III. Results 8
IV. Discussion 13
V. Conclusions 17
References 18
논문요약 21

참고문헌 (Reference)

1. WHO Classification of Tumours, Digestive System Tumours, Klimstra D, Odze RD, Rugge M, Schirmacher P et al, Paradis V, Nagtegaal ID, Lyon: International Agency for Reearch on Cancer, , 2019

2. Origin of pancreatic endocrine cells from biliary duct epithelium, Tosh D, Slack JM., Eberhard D, 65:34673480, , 2008

3. Intraductal papillary neoplasia of the liver associated with hepatolithiasis, Zen Y, Yeh TS et al, Nakanuma Y, Jan YY, Chen TC, Chen MF, 34:651658, , 2001

4. A comparative study of intraductal papillary neoplasia of the biliary tract and pancreas, Erdogan D, Van Der Gaag NA, Rauws EA, Kloek JJ, Busch OR, Gouma DJ et al, 42:824832, , 2011

5. GNAS codon 201 mutations are uncommon in intraductal papillary neoplasms of the bile duct, Matthaei H, Wu J, Dal Molin M, Debeljak M, Lingohr P, Katabi N et al, 14:677683, , 2012

6. Clinicopathologic analysis of intraductal papillary neoplasm of bile duct: Korean multicenter cohort study, Jang KT, Jang JY, Kim H et al, Kim JR, Lee K, Kim JH, HPB (Oxford) 22:11391148, , 2020

7. Recurrence After Resection for Intraductal Papillary Neoplasm of Bile Duct (IPNB) According to Tumor Location, Han IW, Heo JS, Choi SH, Choi DW, Jang KT et al, You Y, 24:804 812, , 2020

8. Pancreatic duct glands (PDGs) are a progenitor compartment responsible for pancreatic ductal epithelial repair, Liss AS, Sontheimer A, Warshaw AL et al, MinoKenudson M, Yamaguchi J, Castillo CF, 15:190202, , 2015

9. Systematic Review and Metaanalysis of Current Experience in Treating IPNB: Clinical and Pathological Correlates, GordonWeeks AN, Jones K, Harriss E, Smith A, Silva M., 263:656 663, , 2016

10. Glandular elements around the intrahepatic bile ducts in man; their morphology and distribution in normal livers, Ohta G., Nakanuma Y, Terada T, 0.3041666667, , 1987