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Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma
BACKGROUND: The clinical relevance of pancreatic intraepithelial neoplasia (PanIN) at the resection margin of pancreatic ductal adenocarcinoma remains unknown. We aimed to investigate its clinical impact at the pancreatic transection margin (PTM) and, based on the result, determine the prognostic va...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310330/ https://www.ncbi.nlm.nih.gov/pubmed/32571348 http://dx.doi.org/10.1186/s12957-020-01900-0 |
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author | Jamiyan, Tsengelmaa Shiraki, Takayuki Kurata, Yoshihiro Ichinose, Masanori Kubota, Keiichi Imai, Yasuo |
author_facet | Jamiyan, Tsengelmaa Shiraki, Takayuki Kurata, Yoshihiro Ichinose, Masanori Kubota, Keiichi Imai, Yasuo |
author_sort | Jamiyan, Tsengelmaa |
collection | PubMed |
description | BACKGROUND: The clinical relevance of pancreatic intraepithelial neoplasia (PanIN) at the resection margin of pancreatic ductal adenocarcinoma remains unknown. We aimed to investigate its clinical impact at the pancreatic transection margin (PTM) and, based on the result, determine the prognostic values of the resection margin status and other clinicopathologic parameters. PATIENTS AND METHODS: We retrospectively analyzed 122 consecutive patients who underwent pancreatoduodenectomy or distal pancreatectomy between 2006 and 2018. Pathologic slides were reviewed and survival data were retrieved from institutional databases. Associations between two variables were investigated by Fisher’s exact test. Survival curves were generated by the Kaplan-Meier method. Prognostic factors were assessed using Cox regression analysis. RESULTS: Tumors were resected without leaving macroscopic remnants. The median follow-up period after surgery was 524.5 days. Cancer-related death (n = 72) was marginally and significantly associated with local recurrence (n = 22) and distant metastasis (n = 79), respectively. Local recurrence and distant metastasis occurred independently. After excluding cases with invasive cancer at any other margin, PanIN-2 or PanIN-3 (n = 21) at the PTM did not adversely affect prognoses compared with normal mucosa or PanIN-1 (n = 57) with statistical significance. R0 resection (n = 78), which is invasive cancer-free at all resection margins, showed somewhat better local recurrence-free and overall survivals as compared with R1 resection (n = 44), which involves invasive cancer at any resection margin, but the differences did not reach statistical significance. In contrast, differentiation grade and nodal metastasis were significant predictors of distant metastasis, and tumor location and differentiation grade were significant predictors of cancer-related death. Although there was no significant difference in differentiation grade between the head cancer and the body or tail cancer, nodal metastasis was significantly more frequent in the former than in the latter. CONCLUSIONS: PanINs at the PTM did not adversely affect prognosis and R0 resection was not found to be a significant prognostic factor. Differentiation grade might be an indicator of occult metastasis and affect patients’ overall survival through distant metastasis. In addition to successful surgical procedures, tumor biology may be even more important as a predictor of postoperative prognosis. |
format | Online Article Text |
id | pubmed-7310330 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-73103302020-06-23 Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma Jamiyan, Tsengelmaa Shiraki, Takayuki Kurata, Yoshihiro Ichinose, Masanori Kubota, Keiichi Imai, Yasuo World J Surg Oncol Research BACKGROUND: The clinical relevance of pancreatic intraepithelial neoplasia (PanIN) at the resection margin of pancreatic ductal adenocarcinoma remains unknown. We aimed to investigate its clinical impact at the pancreatic transection margin (PTM) and, based on the result, determine the prognostic values of the resection margin status and other clinicopathologic parameters. PATIENTS AND METHODS: We retrospectively analyzed 122 consecutive patients who underwent pancreatoduodenectomy or distal pancreatectomy between 2006 and 2018. Pathologic slides were reviewed and survival data were retrieved from institutional databases. Associations between two variables were investigated by Fisher’s exact test. Survival curves were generated by the Kaplan-Meier method. Prognostic factors were assessed using Cox regression analysis. RESULTS: Tumors were resected without leaving macroscopic remnants. The median follow-up period after surgery was 524.5 days. Cancer-related death (n = 72) was marginally and significantly associated with local recurrence (n = 22) and distant metastasis (n = 79), respectively. Local recurrence and distant metastasis occurred independently. After excluding cases with invasive cancer at any other margin, PanIN-2 or PanIN-3 (n = 21) at the PTM did not adversely affect prognoses compared with normal mucosa or PanIN-1 (n = 57) with statistical significance. R0 resection (n = 78), which is invasive cancer-free at all resection margins, showed somewhat better local recurrence-free and overall survivals as compared with R1 resection (n = 44), which involves invasive cancer at any resection margin, but the differences did not reach statistical significance. In contrast, differentiation grade and nodal metastasis were significant predictors of distant metastasis, and tumor location and differentiation grade were significant predictors of cancer-related death. Although there was no significant difference in differentiation grade between the head cancer and the body or tail cancer, nodal metastasis was significantly more frequent in the former than in the latter. CONCLUSIONS: PanINs at the PTM did not adversely affect prognosis and R0 resection was not found to be a significant prognostic factor. Differentiation grade might be an indicator of occult metastasis and affect patients’ overall survival through distant metastasis. In addition to successful surgical procedures, tumor biology may be even more important as a predictor of postoperative prognosis. BioMed Central 2020-06-22 /pmc/articles/PMC7310330/ /pubmed/32571348 http://dx.doi.org/10.1186/s12957-020-01900-0 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Jamiyan, Tsengelmaa Shiraki, Takayuki Kurata, Yoshihiro Ichinose, Masanori Kubota, Keiichi Imai, Yasuo Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma |
title | Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma |
title_full | Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma |
title_fullStr | Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma |
title_full_unstemmed | Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma |
title_short | Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma |
title_sort | clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310330/ https://www.ncbi.nlm.nih.gov/pubmed/32571348 http://dx.doi.org/10.1186/s12957-020-01900-0 |
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