ArticleJournal of the National Cancer Institute2024
An international multi-institutional validation of T1 sub-staging of intraductal papillary mucinous neoplasm-derived pancreatic cancer.
Article in Journal of the National Cancer Institute, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The molecular mechanism of cuproptosis and research progress in pancreatic diseases.Annals of medicine · 2026Pooled it
- Implications and risk of new versus persisting intraductal papillary mucinous neoplasms after pancreatic surgery: meta-analysis.BJS open · 2026Pooled it
- Cancer Risk After Initial Surveillance of Intraductal Papillary Mucinous Neoplasms (IPMNs): Are We Missing the Window for Prevention?Annals of surgical oncology · 2026Article
- Informing Decision-making for Transected Margin Reresection in Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer: An International Multicenter Study.Annals of surgery · 2026Article
- From Postoperative Prognosis to Preoperative Decision-Making in IPMN.United European gastroenterology journal · 2026Article
- Survival After Pancreatic Resection for Intraductal Papillary Mucinous Neoplasm: Supporting Selective Surgery.United European gastroenterology journal · 2026Observational
- Incidence and Outcomes of Intraductal Oncocytic Papillary Neoplasm-Derived Pancreatic Cancer Compared with Tubular and Colloid Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: An International Multicenter Retrospective Study.Annals of surgical oncology · 2025Observational
- Essential Update 2023/2024: Multidisciplinary Treatment for Invasive Intraductal Papillary Mucinous Carcinoma.Annals of gastroenterological surgery · 2025Review
- Evaluation of AJCC Nodal Staging for Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Ductal Adenocarcinoma.Annals of surgical oncology · 2024Article
- ASO Author Reflections: Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: A Need to Evaluate for Specific Staging Systems.Annals of surgical oncology · 2024Article
Corrections and comments
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Authors and funding
17 authors.
Funding
Abstract
backgroundIntraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) is resected at smaller sizes compared with its biologically distinct counterpart, pancreatic intraepithelial neoplasia (PanIN)-derived PDAC. Thus, experts proposed T1 sub-staging for IPMN-derived PDAC. However, this has never been validated.
methodsConsecutive upfront surgery patients with IPMN-derived PDAC from 5 international high-volume centers were classified by the proposed T1 sub-staging classification (T1a ≤0.5, T1b >0.5 and ≤1.0, and T1c >1.0 and ≤2.0 cm) using the invasive component size. Kaplan-Meier and log-rank tests were used to compare overall survival (OS). A multivariable Cox regression was used to determine hazard ratios (HRs) with confidence intervals (95% CIs).
resultsAmong 747 patients, 69 (9.2%), 50 (6.7%), 99 (13.0%), and 531 patients (71.1%), comprised the T1a, T1b, T1c, and T2-4 subgroups, respectively. Increasing T-stage was associated with elevated CA19-9, poorer grade, nodal positivity, R1 margin, and tubular subtype. Median OS for T1a, T1b, T1c, and T2-4 were 159.0 (95% CI = 126.0 to NR), 128.8 (98.3 to NR), 77.6 (48.3 to 108.2), and 31.4 (27.5 to 37.7) months, respectively (P < .001). OS decreased with increasing T-stage for all pairwise comparisons (all P < .05). After risk adjustment, older than age 65, elevated CA19-9, T1b [HR = 2.55 (1.22 to 5.32)], T1c [HR = 3.04 (1.60 to 5.76)], and T2-4 [HR = 3.41 (1.89 to 6.17)] compared with T1a, nodal positivity, R1 margin, and no adjuvant chemotherapy were associated with worse OS. Disease recurrence was more common in T2-4 tumors (56.4%) compared with T1a (18.2%), T1b (23.9%), and T1c (36.1%, P < .001).
conclusionT1 sub-staging of IPMN-derived PDAC is valid and has significant prognostic value. Advancing T1 sub-stage is associated with worse histopathology, survival, and recurrence. T1 sub-staging is recommended for future guidelines.
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