Lucocq, James and Hawkyard, Jake and Haugk, Beate and Mownah, Omar and Menon, Krishna and Furukawa, Takaki and Inoue, Yosuke and Hirose, Yuki and Sasahira, Naoki and Feretis, Michael and Balakrishnan, Anita and Ceresa, Carlo and Davidson, Brian and Pande, Rupaly and Dasari, Bobby and Tanno, Lulu and Karavias, Dimitrios and Helliwell, Jack and Young, Alistair and Nunes, Quentin and Urbonas, Tomas and Silva, Michael and Gordon-Weeks, Alex and Barrie, Jenifer and Gomez, Dhanny and Van Laarhoven, Stijn and Robertson, Francis and Nawara, Hossain and Doyle, Joseph and Bhogal, Ricky and Harrison, Ewen and Roalso, Marcus and Ciprani, Debora and Aroori, Somaiah and Ratnayake, Bathiya and Koea, Jonathan and Capurso, Gabriele and Bellotti, Ruben and Stättner, Stefan and Alsaoudi, Tareq and Bhardwaj, Neil and Rajesh, Srujan and Jeffery, Fraser and Connor, Saxon and Cameron, Andrew and Jamieson, Nigel and Sheen, Amy and Mittal, Anubhav and Samra, Jas and Gill, Anthony and Roberts, Keith and Søreide, Kjetil and Pandanaboyana, Sanjay (2024) Adjuvant chemotherapy for adenocarcinoma arising from intraductal papillary mucinous neoplasia: multicentre ADENO-IPMN study. British Journal of Surgery, 111 (4): znae100. ISSN 0007-1323

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Abstract

Background: The clinical impact of adjuvant chemotherapy after resection for adenocarcinoma arising from intraductal papillary mucinous neoplasia is unclear. The aim of this study was to identify factors related to receipt of adjuvant chemotherapy and its impact on recurrence and survival. Methods: This was a multicentre retrospective study of patients undergoing pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasia between January 2010 and December 2020 at 18 centres. Recurrence and survival outcomes for patients who did and did not receive adjuvant chemotherapy were compared using propensity score matching. Results: Of 459 patients who underwent pancreatic resection, 275 (59.9%) received adjuvant chemotherapy (gemcitabine 51.3%, gemcitabine–capecitabine 21.8%, FOLFIRINOX 8.0%, other 18.9%). Median follow-up was 78 months. The overall recurrence rate was 45.5% and the median time to recurrence was 33 months. In univariable analysis in the matched cohort, adjuvant chemotherapy was not associated with reduced overall (P = 0.713), locoregional (P = 0.283) or systemic (P = 0.592) recurrence, disease-free survival (P = 0.284) or overall survival (P = 0.455). Adjuvant chemotherapy was not associated with reduced site-specific recurrence. In multivariable analysis, there was no association between adjuvant chemotherapy and overall recurrence (HR 0.89, 95% c.i. 0.57 to 1.40), disease-free survival (HR 0.86, 0.59 to 1.30) or overall survival (HR 0.77, 0.50 to 1.20). Adjuvant chemotherapy was not associated with reduced recurrence in any high-risk subgroup (for example, lymph node-positive, higher AJCC stage, poor differentiation). No particular chemotherapy regimen resulted in superior outcomes. Conclusion: Chemotherapy following resection of adenocarcinoma arising from intraductal papillary mucinous neoplasia does not appear to influence recurrence rates, recurrence patterns or survival.

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