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

Jean R. Park, Feng Li, Veeral M. Oza, Brett C. Sklaw, Kevin M. Cronley, Michael Wellner, Benjamin Swanson, Somashekar G. Krishna

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)202-208
Number of pages7
JournalHepatobiliary and Pancreatic Diseases International
Volume16
Issue number2
DOIs
StatePublished - Apr 15 2017

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Survival
Adenocarcinoma
Neoplasms
Pathology
Chronic Pancreatitis
Disease Management
Pancreatic Neoplasms
Tertiary Care Centers
Pancreas
Regression Analysis
Demography
Databases
Recurrence

Keywords

  • intraductal papillary mucinous neoplasms
  • pancreatic ductal adenocarcinoma
  • pancreatic intraepithelial neoplasia
  • pancreatic neoplasia

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

High-grade pancreatic intraepithelial lesions : prevalence and implications in pancreatic neoplasia. / Park, Jean R.; Li, Feng; Oza, Veeral M.; Sklaw, Brett C.; Cronley, Kevin M.; Wellner, Michael; Swanson, Benjamin; Krishna, Somashekar G.

In: Hepatobiliary and Pancreatic Diseases International, Vol. 16, No. 2, 15.04.2017, p. 202-208.

Research output: Contribution to journalArticle

Park, Jean R. ; Li, Feng ; Oza, Veeral M. ; Sklaw, Brett C. ; Cronley, Kevin M. ; Wellner, Michael ; Swanson, Benjamin ; Krishna, Somashekar G. / High-grade pancreatic intraepithelial lesions : prevalence and implications in pancreatic neoplasia. In: Hepatobiliary and Pancreatic Diseases International. 2017 ; Vol. 16, No. 2. pp. 202-208.
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abstract = "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.",
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T1 - High-grade pancreatic intraepithelial lesions

T2 - prevalence and implications in pancreatic neoplasia

AU - Park, Jean R.

AU - Li, Feng

AU - Oza, Veeral M.

AU - Sklaw, Brett C.

AU - Cronley, Kevin M.

AU - Wellner, Michael

AU - Swanson, Benjamin

AU - Krishna, Somashekar G.

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N2 - 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.

AB - 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.

KW - intraductal papillary mucinous neoplasms

KW - pancreatic ductal adenocarcinoma

KW - pancreatic intraepithelial neoplasia

KW - pancreatic neoplasia

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