Background: Adjuvant therapy (AT) has demonstrated survival benefits in patients with pancreatic ductal adenocarcinoma (PDAC). However, the oncologic efficacy of AT in resected invasive intraductal papillary mucinous neoplasms (IPMN) remains unclear, and there are no established guidelines in this context. Method: We retrospectively analyzed 539 patients with invasive pancreatic IPMN treated between 2005 and 2020 across 18 centers in Korea. Propensity score-matched (PSM) and stage-matched survival analyses were performed. Results: A total of 354 patients were enrolled in a 1:1 PSM analysis. Multivariate analysis identified perineural invasion (HR, 2.589; 95% CI, 1.528–4.385; P 37 (HR, 2.032; 95% CI, 1.227–3.364; P < 0.001) as adverse prognostic factors for resected invasive IPMN. In the overall cohort, there were no significant differences in disease-free survival (DFS) and overall survival (OS) between the surgery-alone (SA) and AT groups ( P = 0.882; P = 0.080). Similarly, in the stage-matched analysis, no significant difference in OS was observed between the SA and AT groups (stage I, P = 0.621; stage II, P = 0.662; stage III, P = 0.571). While DFS was improved in the stage I group compared to the SA group ( P = 0.020), this benefit was not observed in other stages. Conclusions: Unlike in PDAC, AT was not associated with an OS benefit for resected invasive IPMN across stages I–III. While its efficacy in patients with poor prognostic factors remains uncertain, further prospective studies are warranted to clarify the role of AT in high-risk subsets.
Choi et al. (2026) studied this question.