Clinical and Pathologic Features Influencing Survival in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Weber, Cynthia E.; Bock, Eileen; Hurtuk, Michael G.; Pickleman, Jack; Shoup, Margo; Aranha, Gerard V.

doi:10.1007/s11605-013-2388-x

Cited by 24 publications

(15 citation statements)

References 25 publications

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“…Complete resection is the most effective modality for improving the survival of PDAC patients, with an estimated 5-year survival rate of 4–25% [2]. Due to the anatomical proximity, direct tumor infiltration of the superior mesenteric vein (SMV)/portal vein (PV) is not uncommon in PDAC.…”

Section: Introductionmentioning

confidence: 99%

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

Song

Liu

et al. 2017

Oncotarget

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BackgroundThe impact of histopathologic tumor invasion of the superior mesenteric vein (SMV)/portal vein (PV) on prognosis in patients with pancreatic ductal adenocarcinoma (PDAC) after pancreatectomy remains controversial. A meta-analysis was performed to assess this issue.ResultsEighteen observational studies comprising 5242 patients were eligible, of whom 2199 (41.9%) patients received SMV/PV resection. Histopathologic tumor invasion was detected in 1218 (58.1%) of the 2096 resected SMV/PV specimens. SMV/PV invasion was associated with higher rates of poor tumor differentiation (P = 0.002), lymph node metastasis (P < 0.001), perineural invasion (P < 0.001), positive resection margins (P = 0.004), and postoperative tumor recurrence (P < 0.001). SMV/PV invasion showed a significantly negative effect on survival in total patients who underwent pancreatectomy with and without SMV/PV resection (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 1.08–1.35; P = 0.001) and in patients who underwent pancreatectomy with SMV/PV resection (HR: 1.88, 95% CI, 1.48–2.39; P < 0.001).Materials And MethodsA systematic literature search was performed to identify articles published from January 2000 to August 2016. Data were pooled for meta-analysis using Review Manager 5.3.ConclusionsHistopathologic tumor invasion of the SMV/PV is associated with more aggressive biologic behavior and could be used as an indicator of poor prognosis after PDAC resection.

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Section: Introductionmentioning

confidence: 99%

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

Song

Liu

et al. 2017

Oncotarget

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“…More specifically, the CART analyses suggest that the two most important risk factors for determining 1-year mortality were the LNR and tumor size, while only the LNR was able to risk-stratify patients at 3 years. A focused, separate analysis of 246 patients with specifically pancreatic adenocarcinoma reported a significant prognostic value of the LNR for both short- and long-term survival after PD [25]. This was similarly confirmed in a recent study of 551 patients who underwent resection for periampullary tumors, and a LNR > 0.2 was identified as an independent prognostic factor for overall survival [28].…”

Section: Discussionmentioning

confidence: 72%

“…In contrast, retrospective evaluations of pancreatic cancer and ampullary carcinoma demonstrated that the number of metastatic nodes, but not LNR, was one of the most important prognostic factors [21, 22]. However, a significant association between the LNR and survival for patients with pancreatic cancer was identified in separate studies [6, 23–25]. Furthermore, using data from patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, the LNR has been shown to be one of the most powerful predictors of short- and long-term survival [25] and has been suggested as a new tool for stratifying patients in future trials [6].…”

Section: Introductionmentioning

confidence: 99%

“…However, a significant association between the LNR and survival for patients with pancreatic cancer was identified in separate studies [6, 23–25]. Furthermore, using data from patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, the LNR has been shown to be one of the most powerful predictors of short- and long-term survival [25] and has been suggested as a new tool for stratifying patients in future trials [6]. Thus, beyond the qualitative LN status (positive or negative nodes), the LNR may provide a quantitative tool that improves the current classification system for periampullary tumors [7, 26].…”

Section: Introductionmentioning

confidence: 99%

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The Association between Survival and the Pathologic Features of Periampullary Tumors Varies over Time

et al. 2014

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Introduction. Several histopathologic features of periampullary tumors have been shown to be correlated with prognosis. We evaluated their association with mortality at multiple time points. Methods. A retrospective chart review identified 207 patients with periampullary adenocarcinomas who underwent pancreaticoduodenectomy between January 1, 2001 and December 31, 2009. Clinicopathologic features were assessed, and the data were analyzed using univariate and multivariate methods. Results. In univariate analysis, perineural invasion had a strong association with 1-year mortality (OR 3.03, CI 1.42–6.47), and one lymph node (LN) increase in the LN ratio (LNR) equated with a 5-fold increase in mortality. In contrast, LN status (OR 6.42, CI 3.32–12.41) and perineural invasion (OR 5.44, CI 2.81–10.52) had the strongest associations with mortality at 3 years. Using Cox proportional hazards, perineural invasion (HR 2.61, CI 1.77–3.85) and LN status (HR 2.69, CI 1.84–3.95) had robust associations with overall mortality. Recursive partitioning analysis identified LNR as the most important risk factor for mortality at 1 and 3 years. Conclusions. Overall mortality was closely related to the LNR within the first year, while longer follow-up periods demonstrated a stronger association with perineural invasion and overall LN status. Therefore, the current staging for periampullary tumors may need to be updated to include the LNR.

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“…This staging system remains the primary consideration by physicians to determine appropriate treatment as well as offer prognostic information for patients and families [3]. Significant ranges in survival exist within individual AJCC clinical stages [4], [5], [6]; for instance, stage IV patients may live only a few weeks after diagnosis or may live longer than one to two years with treatment. It is likely that this intra-stage variance is due to heterogeneous tumor gene expression resulting in differences in tumor biology.…”

Section: Introductionmentioning

confidence: 99%

A Thirteen-Gene Expression Signature Predicts Survival of Patients with Pancreatic Cancer and Identifies New Genes of Interest

et al. 2014

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BackgroundCurrently, prognostication for pancreatic ductal adenocarcinoma (PDAC) is based upon a coarse clinical staging system. Thus, more accurate prognostic tests are needed for PDAC patients to aid treatment decisions.Methods and FindingsAffymetrix gene expression profiling was carried out on 15 human PDAC tumors and from the data we identified a 13-gene expression signature (risk score) that correlated with patient survival. The gene expression risk score was then independently validated using published gene expression data and survival data for an additional 101 patients with pancreatic cancer. Patients with high-risk scores had significantly higher risk of death compared to patients with low-risk scores (HR 2.27, p = 0.002). When the 13-gene score was combined with lymph node status the risk-score further discriminated the length of patient survival time (p<0.001). Patients with a high-risk score had poor survival independent of nodal status; however, nodal status increased predictability for survival in patients with a low-risk gene signature score (low-risk N1 vs. low-risk N0: HR = 2.0, p = 0.002). While AJCC stage correlated with patient survival (p = 0.03), the 13-gene score was superior at predicting survival. Of the 13 genes comprising the predictive model, four have been shown to be important in PDAC, six are unreported in PDAC but important in other cancers, and three are unreported in any cancer.ConclusionsWe identified a 13-gene expression signature that predicts survival of PDAC patients and could prove useful for making treatment decisions. This risk score should be evaluated prospectively in clinical trials for prognostication and for predicting response to chemotherapy. Investigation of new genes identified in our model may lead to novel therapeutic targets.

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Clinical and Pathologic Features Influencing Survival in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Abstract: The strongest prognostic variable for short- and long-term survival after PD for PDA is lymph node ratio. Short-term survival is influenced by the postoperative course.

Cited by 24 publications

References 25 publications

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

Histopathologic tumor invasion of superior mesenteric vein/ portal vein is a poor prognostic indicator in patients with pancreatic ductal adenocarcinoma: results from a systematic review and meta-analysis

The Association between Survival and the Pathologic Features of Periampullary Tumors Varies over Time

A Thirteen-Gene Expression Signature Predicts Survival of Patients with Pancreatic Cancer and Identifies New Genes of Interest

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