Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2023; 15(5): 843-858
Published online May 15, 2023. doi: 10.4251/wjgo.v15.i5.843
Epidemiology and outcome of individuals with intraductal papillary neoplasms of the bile duct
Rong-Shou Wu, Wen-Jun Liao, Jing-Sheng Ma, Jia-Kun Wang, Lin-Quan Wu, Ping Hou
Rong-Shou Wu, Wen-Jun Liao, Jia-Kun Wang, Lin-Quan Wu, Ping Hou, Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
Jing-Sheng Ma, Department of Organ Transplantation, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
Ping Hou, Department of General Surgery, The First Affiliated Hospital of Gannan Medical College, No. 23 Qingnian Road, Zhanggong District, Ganzhou 341000, Jiangxi Province, China
Author contributions: Wu RS and Liao WJ contributed equally to this work, Wu RS and Hou P contributed to the conceptualization, formal analysis, software, and writing-original draft; Liao WJ and Wu LQ contributed to the conceptualization, writing-review and editing, project administration; Ma JS and Wang JK contributed to the data curation and methodology. All authors had access to the study data and reviewed and approved the final article. All authors read and approved the final manuscript
Supported by the National Natural Science Foundation of China, No. 81860431 and 82060447; and the Jiangxi Natural Science Foundation, No. 20181BBG70025.
Institutional review board statement: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute belong to public databases. The patients involved in the database have obtained ethical approval.
Conflict-of-interest statement: The authors declare no conflict of interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at houping1986@16.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ping Hou, PhD, Surgeon, Surgical Oncologist, Department of General Surgery Department, The First Affiliated Hospital of Gannan Medical College, No. 23 Qingnian Road, Zhanggong District, Ganzhou 341000, Jiangxi Province, China. houping1986@126.com
Received: November 5, 2022
Peer-review started: November 5, 2022
First decision: February 2, 2023
Revised: February 16, 2023
Accepted: March 15, 2023
Article in press: March 15, 2023
Published online: May 15, 2023
Processing time: 188 Days and 4.4 Hours
Abstract
BACKGROUND

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare distinct subtype of precursor lesions of biliary carcinoma. IPNB is considered to originate from luminal biliary epithelial cells, typically displays mucin-hypersecretion or a papillary growth pattern, and results in cystic dilatation[1]. IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts, and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma. IPNBs have similar phenotypic changes in the occurrence and development of all subtypes, and the prognosis is significantly better than that of traditional (non-papillary) cholangiocarcinoma.

AIM

To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.

METHODS

Invasive IPNB, invasive intraductal papillary mucinous neoplasm of the pancreas (IPMN), and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Annual percentage changes (APCs) in the incidence and incidence-based (IB) mortality were calculated. We identified the independent predictors of overall survival (OS) and cancer-specific survival (CSS) in individuals with invasive IPNB.

RESULTS

The incidence and IB mortality of invasive IPNB showed sustained decreases, with an APC of -4.5% (95%CI: -5.1% to -3.8%) and -3.3% (95%CI: -4.1% to -2.6%) (P < 0.001), respectively. Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma. Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma. A total of 1635 individuals with invasive IPNB were included in our prognosis analysis. The most common tumor sites were the pancreaticobiliary ampulla (47.9%) and perihilar tract (36.7%), but the mucin-related subtype of invasive IPNB was the main type, intrahepatically (approximately 90%). In the univariate and multivariate Cox regression analysis, age, tumor site, grade and stage, subtype, surgery, and chemotherapy were associated with OS and CSS (P < 0.05).

CONCLUSION

Incidence and IB mortality of invasive IPNB trended steadily downward. The heterogeneity of IPNB comprises site and the tumor’s mucin-producing status.

Keywords: Surveillance, Epidemiology, and End Results database; Intraductal papillary neoplasms of the bile duct; Subtype; Annual percentage changes; Prognosis

Core Tip: Intraductal papillary neoplasms of the bile duct (IPNB) is a rare subtype of biliary cholangiocarcinoma, and also considered as a counterpart of intraductal papillary mucinous neoplasm of the pancreas (IPMN). Current management decisions are based on anecdotal evidence and small case series. There have been no large-sample multicenter studies of IPNB. This manuscript aimed to evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.