High grade of neural invasion is the strongest predictor for local recurrence in pancreatic cancer

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) is characterized by devasting poor survival, even with curative intended resection. Almost 100% of the resected patients have a neural invasion of the tumor [1] . The aim of this study is to estimate the impact of the degree of neural invasion on survival and tumor recurrence in PDAC. Methods: Neural Invasion was assessed in tumor tissue of 225 patients, who were resected at our Department between 07/2007 and 10/2014 for histological confirmed PDAC. A Neural Invasion Index (NII) based on the Neural Invasion Severity Score: 1x epineural invasion+2x perineural invasion+3x endoneural invasion was calculated [1]. Results: 96.3% of all included patients had a neural invasion. A higher NII was significantly associated with advanced tumor disease, as indicated by larger tumor size, lymph node metastases and extended resections. Multiple Cox proportional hazard model revealed NII as strongest independent predictor for local recurrence (p<0.0001) and also as an independent predictor for overall survival (p=0.001) and distant metastases (p=0.04). Conclusion: Number and invasiveness of neural invasionassessed with NII is a very important and valid prognostic marker, especially for local recurrence.References:[1] Liebl F, Demir, E, Ceyhan, G et al., (2014), The impact of neural invasion severity in gastrointestinal malignancies: a clinicopathological study, Ann Surg