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

doi:10.4251/wjgo.v15.i5.843

Epidemiology and outcome of individuals with intraductal papillary neoplasms of the bile duct

World J Gastrointest Oncol. 2023 May 15;15(5):843-858. doi: 10.4251/wjgo.v15.i5.843.

Authors

Rong-Shou Wu¹, Wen-Jun Liao¹, Jing-Sheng Ma², Jia-Kun Wang¹, Lin-Quan Wu¹, Ping Hou^{1

3}

Affiliations

¹ Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China.
² Department of Organ Transplantation, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China.
³ Department of General Surgery, The First Affiliated Hospital of Gannan Medical College, No. 23 Qingnian Road, Zhanggong District, Ganzhou 341000, Jiangxi Province, China. houping1986@126.com.

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