A search for prognostic factors in cancer of the pancreatic head: The significance of the DNA ploidy pattern

Takada, Tadahiro; Yasuda, Hideki

doi:10.1016/s0960-7404(10)80002-7

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…Αυτό μπορεί να οφείλεται στην εκδήλωση οξείας παγκρεατίτιδας σε συνδυασμό με τον καρκίνο του παγκρέατος. Οι μελέτες των Allema (202)(203)(204)(205) και Cubiella (617) δεν απέδειξαν την προγνωστική αξία της αύξησης της αμυλάσης σε ασθενείς με προχωρημένο καρκίνο του παγκρέατος.…”

Section: θεραπείαunclassified

“…Στο χειρουργήσιμο καρκίνο του παγκρέατος, ο αριθμός των μεταγγίσεων είναι αντιστρόφως ανάλογος με την επιβίωση (8)(9)(10)(11)(12)(13)(14)(15)(16)29,(202)(203)(204)(205)232,(410)(411)(412), η άποψη όμως αυτή αμφισβητείται (16,(209)(210)(211).…”

Section: θεραπείαunclassified

“…ΔΗΜΟΓΡΑΦΙΚΟΙ ΠΑΡΑΓΟΝΤΕΣ (α) Ηλικία Η ηλικία δε βρέθηκε να επηρεάζει την επιβίωση των ασθενών με ανεγχείρητο (617-623) ή χειρουργήσιμο καρκίνο του παγκρέατος(8-16,202-205,209-214,232,393-395,195,536,537,624- 631). (β) ΦύλοΤο φύλο δε σχετίζεται με την επιβίωση των ασθενών με καρκίνο του παγκρέατος, τόσο αυτών που χειρουργήθηκαν(8)(9)(10)(11)(12)(13)(14)(15)(16)28,(202)(203)(204)(205)(209)(210)(211)232,(393)(394)(395)(410)(411)(412)536,537,(624)(625)(626)(627)(628)(629)(630)(631), όσο και αυτών με ανεγχείρητο καρκίνο του παγκρέατος(617)(618)(619)(620)(621)(622)(623). Μόνο σε δύο μελέτες βρέθηκε ότι οι γυναίκες είχαν καλύτερη πρόγνωση(212)(213)(214)(470)…”

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“…Σύμφωνα με τη μελέτη των Fujishiro et al(1091), ασθενείς με πρόγνωση συγκριτικά με αυτούς που δεν μεταγγίσθηκαν, γεγονός που παρατηρείται και σε άλλες νεοπλασίες(1078,1079), όπως του παχέος εντέρου(1080,1081,(1085)(1086)(1087) και του μαστού(1082)(1083)(1084). Στο χειρουργήσιμο καρκίνο του παγκρέατος, ο αριθμός των μεταγγίσεων είναι αντιστρόφως ανάλογος με την επιβίωση(8)(9)(10)(11)(12)(13)(14)(15)(16)29,(202)(203)(204)(205)232,(410)(411)(412), η άποψη όμως αυτή αμφισβητείται(16,(209)(210)(211). Ωστόσο μεταγγιζόμενος ασθενής σημαίνει και ασθενής με όχι καλή γενική κατάσταση, οπότε τίθεται το ερώτημα κατά πόσο ευθύνεται για την μείωση της επιβίωσης η κακή γενική κατάσταση ή η μετάγγιση αίματος.…”

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Διερεύνηση Προγνωστικών Παραγόντων Και Πλοειδικότητα Στον Καρκίνο Του Παγκρέατος

Τσιγκρίτης¹

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Σελ. 118-175 ΠΡΟΣΩΠΙΚΑ ΣΤΟΙΧΕΙΑ ΟνοματεπώνυμοΤσιγκρίτης Κωνσταντίνος Όνομα πατρός Ιωακείμ Όνομα μητρός ΠαρασκευήΗμερομηνία γεννήσεως 19 Οκτωβρίου1972 Τόπος γεννήσεωςΒιλ Σαιντ Γκάλλεν, Ελβετία Οικογενειακή κατάσταση ΆγαμοςΕθνικότητα Ελληνική Διεύθυνση κατοικίαςΣαράντα Εκκλησιών 24,

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Section: θεραπείαunclassified

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Διερεύνηση Προγνωστικών Παραγόντων Και Πλοειδικότητα Στον Καρκίνο Του Παγκρέατος

Τσιγκρίτης¹

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Cancer of the Pancreas

Roder

Ott

2014

TNM Online

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Pancreatic cancer remains an important cause of death in many nations. In most patients pancreatic adenocarcinoma is diagnosed at a stage of disease that is not curable by surgery and can only be little affected by multimodality treatment options (chemotherapy, radiotherapy, immunotherapy). Surgery is the only curative approach, but success with resection is low and the prognosis remains extremely poor, for example, patients with completely resected tumors have a 5‐year survival rate of 15–28%. The overall 5‐year survival remains extremely low despite a slight improvement during the last few years: figures of 1–3% for all, and 5–25% for resected patients are reported. More than 90–95% of carcinomas of the pancreas are exocrine tumors. Over 90% of these tumors, as referred to in the World Health Organization (WHO) classification, are ductal adenocarcinomas, including rare types, such as mucinous noncystic, adenosquamous, anaplastic, and osteoblast‐like giant‐cell carcinoma. The mucinous cystadenocarcinoma (about 1% of all cases or 5% of resected cases) had a relatively good prognosis and a 5‐year survival rate of 54.3% in a Japanese study. Also, the uncommon intraductal papillary mucinous adenocarcinoma has a better prognosis than the common ductal adenocarcinoma. These two tumor types, as well as the carcinoma in situ, are excluded in the following review of prognostic factors. The most important prognostic factor is the possibility of curative resection. The outcome of patients who undergo resection is definitely superior to those not undergoing resection. In the literature the resection rates for exocrine pancreatic carcinoma range from 2.6% to 30%. In contrast to patients without resection, who practically never show a long‐term survival rate, in specialized centers resected patients show a 5‐year survival rate of 20–25%. The median survival time for resected patients is 10–20 months. Therefore, the prognostic factors for those patients who have not been resected will be discussed separately in the section on treatment‐related prognostic factors. Due to the small number of resected patients and the poor prognosis, the importance of several prognostic factors still remains unclear, because most studies are based on univariate analysis. Only a few studies with more than 100 resected patients analyzed by multivariate analysis have been published. In the following analysis of prognostic factors, the relevant international literature will be considered. Problems in reviewing the actual literature are that often carcinomas of the head of the pancreas are not separated from those of the ampulla of Vater and the distal bile duct, which have a better prognosis. Furthermore, in 1997 the new International Union Against Cancer Tumors, Nodules, Metastases (UICC TNM) classification (5th ed.) was published this manual relates better to prognosis than does the old classification (4th ed.). Also, in the interpretation of prognostic factors, the reduction of perioperative mortality to less than 5% also has to be considered.

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A Proposal for a New and More Practical Grading Scheme for Pancreatic Ductal Adenocarcinoma

Adsay¹,

Basturk²,

Bonnett³

et al. 2005

American Journal of Surgical Pathology

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There is no uniformly applied grading system for pancreatic ductal adenocarcinoma (DA). The scheme advocated by the WHO is essentially that of Kloppel et al, and is based on the "highest grade" focus. Although it is precise with good prognostic value, it is unfortunately not widely applied, largely because of the lack of recognition and partly because of its complex nature (interpretation of multiple parameters). Furthermore, it is fundamentally different from the one used in Japan, which evaluates the overall pattern. To establish a more widely applicable, practical, and clinically relevant grading system, a scheme similar to Gleason's scoring system was developed and tested on 112 cases of resected pancreatic DA and was compared with the WHO system. In the grading system devised, patterns (P) of infiltration were classified as follows: P1, well-defined glands with easily discernible contours; P2, fused or poorly formed glands with ill-defined contours; P3, nonglandular patterns. A score was then obtained by the summation of the predominant and the secondary patterns. Scores < or =3 (at least some well-formed glands and no nonglandular pattern) was graded as G1, 4 as G2, and > or =5 (at least some nonglandular patterns and no well-formed glandular pattern) as G3. Seventy-three percent of the cases displayed mixed patterns, with disparate patterns (P1 with P3) in 13%, confirming the high degree of heterogeneity of DA. There was a significant correlation between grade and survival, better than the correlation between survival and either the major or minor patterns evaluated separately. The median survival for G1, G2, and G3 were 22, 14, and 8 months; 1-year survival 68%, 44%, and 33%; 2-year was 67%, 11%, and 0%; and 3-year was 23%, 4%, and 0%, respectively (P = 0.0019). In a multivariate analysis, correlating survival with grade, tumor size, and lymph node status, the grade was the strongest independent predictor of survival. Odds ratio of dying of disease were 3.56 (P < 0.0001) in G3 versus G1, 1.79 (P = 0.058) in G2 versus G1, and 1.98 (P = 0.03) in G3 versus G2. Compared with this, the same odds ratio were 1.17 (P = 0.01) in tumors >2 cm versus < or =2 cm and 1.78 (P = 0.01) in cases with positive versus negative lymph nodes. The WHO grading scheme was not found to have as good a correlation with survival in this study, with WHO grade 2 showing a better survival than 1. The reproducibility of both the proposed grading system and that of WHO were found to be moderately good (with kappa values of 0.43 and 0.44, respectively), when 32 slides of DA were graded by four independent observers. The grading scheme for pancreatobiliary adenocarcinoma proposed here is highly applicable because it is practical and readily adoptable. It reflects biologic characteristics of ductal carcinoma (prominent tubule formation and tumor heterogeneity). Most importantly, it is clinically relevant with good prognostic value. Lastly, it is also applicable for use in research, by utilizing "patterns," even in small specimens like microa...

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A search for prognostic factors in cancer of the pancreatic head: The significance of the DNA ploidy pattern

Cited by 3 publications

References 14 publications

Διερεύνηση Προγνωστικών Παραγόντων Και Πλοειδικότητα Στον Καρκίνο Του Παγκρέατος

Διερεύνηση Προγνωστικών Παραγόντων Και Πλοειδικότητα Στον Καρκίνο Του Παγκρέατος

Cancer of the Pancreas

A Proposal for a New and More Practical Grading Scheme for Pancreatic Ductal Adenocarcinoma

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