Impact of Tumor Grade on Pancreatic Cancer Prognosis: Validation of a Novel TNMG Staging System

Rochefort, Matthew M.; Ankeny, Jacob S.; Kadera, Brian E.; Donald, Graham; Isacoff, William H.; Wainberg, Zev A.; Hines, Oscar J.; Donahue, Timothy R.; Reber, Howard A.; Tomlinson, James S.

doi:10.1245/s10434-013-3159-3

Cited by 89 publications

(52 citation statements)

References 13 publications

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“…Furthermore, the revised R0 definition in 2005 contributed significantly to increased rates of R1 resections and purified those with R0 [12]. Similar rates of R0 resections in younger and older patients (58.7 vs. 62%, respectively) were observed in our series with other reports supporting our data [22]. However, they appeared to be the strongest negative prognosticator (HR 1.76) in younger patients only.…”

Section: Discussionsupporting

confidence: 89%

Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Urbonas¹,

Gulbinas

Smailytė

et al. 2015

Dig Surg

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Background: It is supposed that a prolonged lifetime will be associated with increased incidence of PDAC among the elderly. Some studies show a tendency toward decreased survival in the elderly patients following pancreatoduodenectomy for PDAC. The aim of this study was to evaluate factors, influencing survival following pancreatoduodenectomy for PDAC in different age groups. Methods: Data of 251 patients after pancreatoduodenectomy for PDAC between 1999 and 2012 were analyzed. The Kaplan-Meier method and log-rank test were used to calculate survival and to compare differences between groups. The Cox proportional hazard model was applied to indentify independent prognosticators. Results: The overall median survival was 14.9 months. Postoperative morbidity was 25.5% with a 5.1% mortality rate. No significant differences in the overall morbidity (22.4 vs. 29.6%) or mortality (2.8 vs. 8.3%) rates were observed between different patients' age groups (<70 years and >70 years). Multivariate analysis revealed R1 resection (HR 1.76) and poor tumor differentiation (G3-G4) (HR 1.48) were independent negative factors for survival in patients <70 years. Lymph-node metastases (N1) - HR 4.89 and perineural invasion - HR 2.73 were independent prognosticators in the elderly. Conclusions: Our study highlighted different factors influencing long-term survival after pancreatoduodenectomy: R1 resection and poor tumor differentiation (G3-G4) were independent negative factors for survival in patients <70 years, while perineural invasion and lymph-node metastases result in worse survival among the elderly.

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Section: Discussionsupporting

confidence: 89%

Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Urbonas¹,

Gulbinas

Smailytė

et al. 2015

Dig Surg

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“…This high frequency of aborted operations further emphasizes the need for better diagnostic and staging biomarkers to inform first-line therapy [7,8]. While newer molecular imaging and biomarker assays have demonstrated promise as a means of improved staging of patients, none have translated into clinical practice [9–11]. …”

Section: Diagnosis and Staging Of Pancreatic Cancermentioning

confidence: 99%

Improving pancreatic cancer diagnosis using circulating tumor cells: prospects for staging and single-cell analysis

Court

Ankeny

Hou

et al. 2015

Expert Review of Molecular Diagnostics

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Pancreatic cancer (PC) is the fourth most common cause of cancer-related death in the USA, primarily due to late presentation coupled with an aggressive biology. The lack of adequate biomarkers for diagnosis and staging confound clinical decision-making and delay potentially effective therapies. Circulating tumor cells (CTCs) are a promising new biomarker in PC. Preliminary studies have demonstrated their potential clinical utility, and newer CTC isolation platforms have the potential to provide clinicians access to tumor tissue in a reliable, real-time manner. Such a ‘liquid biopsy’ has been demonstrated in several cancers, and small studies have demonstrated its potential applications in PC. This article reviews the available literature on CTCs as a biomarker in PC and presents the latest innovations in CTC research as well as their potential applications in PC.

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“…The most common pancreatic cancer is the adenocarcinoma of the pancreatic head [1]. Tumour characterization and accurate delineation is essential for staging and pre-operative planning, as in addition to TNM staging, the degree of malignancy, called tumour grading is a decisive parameter of survival [3, 4]. So far, tumour grading is done histologically, which requires invasive biopsy sampling.…”

Section: Introductionmentioning

confidence: 99%

CT-perfusion measurements in pancreatic carcinoma with different kinetic models: Is there a chance for tumour grading based on functional parameters?

et al. 2016

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BackgroundTo evaluate the interchangeability of perfusion parameters obtained with help of models used for post-processing of perfusion-CT images in pancreatic adenocarcinoma and to determine the mean values and ranges of perfusion in different tumour gradings.MethodsPerfusion-CT imaging was performed prospectively in 48 consecutive patients with pancreatic adenocarcinoma. In 42 patients biopsy-proven tumor grading was available (4 × G1/24 × G2/14 × G3/6× unknown). Images were post-processed using a model based on the maximum-slope (MS) approach (blood flow-BFMS) + Patlak analysis (P) (blood volume [BVP] and permeability [k-transP]), as well as a model with deconvolution-based (D) analysis (BFD, BVD and k-transD). 50 mL contrast agent were applied with a delay time of 7 s. Perfusion parameters were compared using intraclass correlation coefficient (ICC), the Wilcoxon matched-pairs test and Bland-Altman plots.ResultsForty eight VOIs of tumours were outlined and analysed. Moderate to good ICC values were found for the perfusion parameters (ICC = 0.62–0.75). Wilcoxon matched-pairs revealed significantly lower values (P < .001 and 0.008), for the BF and BV values obtained using the maximum-slope approach + Patlak analysis compared to deconvolution based analysis. For k-trans measurement, deconvolution revealed significantly lower values (P < 0.001). Different histologic subgroups (G1-G3) did not show significantly different functional parameters.ConclusionThere were significant differences in the perfusion parameters obtained using the different calculation methods, and therefore these parameters are not directly interchangeable. However, the magnitude of pairs of parametric values is in constant relation to each other enabling the use of any of these methods. VPCT parameters did not allow for histologic classification.

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Impact of Tumor Grade on Pancreatic Cancer Prognosis: Validation of a Novel TNMG Staging System

Cited by 89 publications

References 13 publications

Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Improving pancreatic cancer diagnosis using circulating tumor cells: prospects for staging and single-cell analysis

CT-perfusion measurements in pancreatic carcinoma with different kinetic models: Is there a chance for tumour grading based on functional parameters?

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