ACG: Pancreatic Adenocarcinoma is More Aggressive in Absence of Intraepithelial PanIn Dysplasia

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(ChemotherapyAdvisor) – Pancreatic adenocarcinoma found in the absence of pancreated intraepithelial neoplasia (PanIN) – dysplasic cells in small-diameter pancreatic ducts – is more aggressive and associated with poorer prognosis than tumors found in the presence of PanIN, according to a retrospective cohort study presented at the American College of Gastroenterology's 77th Annual Scientific Meeting in Las Vegas, NV.

“We demonstrate here that pancreatic adenocarcinoma without PanIN lesions are associated with poor survival, controlling for stage of disease and age of patient,” reported lead author Benjamin Hassid, MD, of the Department of Medicine at Columbia University in New York, and coauthors.

“This may suggest tumors without PanIN are more aggressive and may be biologically distinct from those developing through the PanIN neoplastic progression route,” Dr. Hassid noted.

PanIN is found both in isolation and, commonly, in association with pancreatic adenocarcinoma. But its prognostic significance for adenocarcinoma is unknown.

So the authors reviewed medical and pathology records for 289 patients who underwent resection for pancreatic adenocarcinoma between 2005 and 2010, noting the highest grade PanINs noted for each patient (graded 1-3 based on degree of atypia), and postsurgical survival time. Demographic variables and tumor stage were also analyzed.

The presence of PanIN of any grade was associated with less aggressive pancreatic cancer and better survival, the team found.

“Kaplan-Meier curves stratified by PanIN grade demonstrated poor survival in the non-PanIN group compared to the other groups (P=0.03),” Dr. Hassid reported. “Median survival in the non-PanIN group was 13 months compared to 31 months for the PanIN 1 group, 24 months for the PanIN 2 group, and 22 months for the PanIN 3 group.”

The mortality hazard ratios (HR) for PanIN Grade 1 patients versus no-PanIN patients was 0.34 (P<0.01), the team reported, 0.50 for PanIN Grade 2 patients versus no-PanIN-group patients (P=0.03), and 0.55 for PanIN Grade 3 (P=0.02), when controlling for tumor stage and patient age, the team reported.


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