Pathological and Radiological Splenic Vein Involvement are Predictors of Poor Prognosis and Early Liver Metastasis After Surgery in Patients with Pancreatic Adenocarcinoma of the Body and Tail

Mizumoto, Toru; Toyama, Hirochika; Asari, Sadaki; Terai, Sachio; Mukubo, Hideyo; Yamashita, Hironori; Shirakawa, Sachiyo; Nanno, Yoshihide; Ueda, Yoshimichi; Sofue, Keitaro; Tanaka, Motofumi; Kido, Masahiro; Ajiki, Tetsuo; Fukumoto, Takumi

doi:10.1245/s10434-017-6274-8

Cited by 21 publications

(21 citation statements)

References 14 publications

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“…In line with our finding that radiologic splenic artery encasement/occlusion is a significant prognostic factor, several previous studies have also demonstrated that pathologic splenic artery invasion, but not splenic vein invasion, was a poor prognostic indicator with an associated reduction in overall survival . However, the results on invasion have not been consistent with other studies showing that instead of splenic artery invasion, splenic vein invasion was an independent and significant prognostic factor . Nevertheless, the lack of correlation between the aforementioned factors and splenic vessel involvement suggests that splenic artery encasement may represent something more than just localized tumor extension.…”

Section: Discussionsupporting

confidence: 53%

“…Previous studies have shown that pathologically confirmed invasion of the splenic artery occurs in 7% to 33% and that of the splenic vein in 31% to 60% of patients undergoing resection for pancreatic adenocarcinoma of the body and tail. [12][13][14][15] These studies also demonstrated that pathologic invasion of the splenic vasculature is a poor prognostic indicator with an associated reduction in overall survival. [12][13][14][15] Similar findings have been reported with pancreatic head cancer where locally advanced disease involving adjacent vasculature is associated with decreased survival.…”

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 91%

“…In line with this practice, it is plausible to conceive that this same strategy may be applicable to lesions in the pancreatic body and tail with regard to the splenic vasculature. However, the aforementioned studies showing the importance of splenic vasculature involvement on the prognosis were all based on the pathologically confirmed invasion . If neoadjuvant treatment is to be considered, splenic vessel invasion must be determined preoperatively with radiographic imaging.…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesize three scenarios in which arterial involvement may have an anatomic and biologic rationale for the more aggressive disease compared with venous involvement. First, those supporting the significance of splenic vein invasion propose that because splenic vein is the major draining vessel of the pancreas body and tail that carries the blood into the liver via portal vein, circulating tumor cells in the splenic/portal vein facilitate early liver metastasis after surgery which in turn lead to decreased overall survival . It is rare to see a tumor involving the splenic artery radiographically without concomitant splenic vein involvement.…”

Section: Discussionmentioning

confidence: 99%

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Significance of radiographic splenic vessel involvement in the pancreatic ductal adenocarcinoma of the body and tail of the gland

Hyun

Rose

Biehl

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Unlike pancreatic head tumors, little is known about the biological significance of radiographic vessel involvement with pancreatic body/tail adenocarcinoma. We hypothesized radiographic splenic vessel involvement may be an adverse prognostic factor. Methods All distal pancreatectomies performed for resectable pancreatic adenocarcinoma between 2000 and 2016 were reviewed and clinicopatholgic data were collected, retrospectively. Preoperative computed tomography imaging was re‐reviewed and splenic vessel involvement was graded as none, abutment, encasement, or occlusion. Results Among a total of 71 patients, splenic artery or vein encasement/occlusion was present in 41% (29 of 71) of patients, each. There were no significant differences in tumor size or grade, margin positivity, and perineural or lymphovascular invasion. However, splenic artery encasement/occlusion (P = 0.001) and splenic vein encasement/occlusion (P = 0.038) both correlated with lymph node positivity. Splenic artery encasement was associated with a reduced median overall survival (20 vs 30 months, P = 0.033). Multivariate analysis also showed that splenic artery encasement was an independent risk factor of worse survival (hazard ratio, 2.246; 95% confidence interval, 1.118‐4.513; P = 0.023). Conclusion Patients with cancer of the body or tail of the pancreas presenting with radiographic encasement of the splenic artery, but not the splenic vein, have a poorer prognosis and perhaps should be considered for neoadjuvant therapy before an attempt at curative resection.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Significance of radiographic splenic vessel involvement in the pancreatic ductal adenocarcinoma of the body and tail of the gland

Hyun

Rose

Biehl

et al. 2019

Journal of Surgical Oncology

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Meta-analysis of recurrence pattern after resection for pancreatic cancer

Tanaka

Mihaljevic

Probst

et al. 2019

British Journal of Surgery

149

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Background: Initial recurrence mapping of resected pancreatic ductal adenocarcinoma (PDAC) could help in stratifying patient subpopulations for optimal postoperative follow-up. The aim of this systematic review and meta-analysis was to investigate the initial recurrence patterns of PDAC and to correlate them with clinicopathological factors.Methods: MEDLINE and Web of Science databases were searched systematically for studies reporting first recurrence patterns after PDAC resection. Data were extracted from the studies selected for inclusion. Pooled odds ratios (ORs) and 95 per cent confidence intervals were calculated to determine the clinicopathological factors related to the recurrence sites. The weighted average of median overall survival was calculated.Results: Eighty-nine studies with 17 313 patients undergoing PDAC resection were included. The weighted median rates of initial recurrence were 20⋅8 per cent for locoregional sites, 26⋅5 per cent for liver, 11⋅4 per cent for lung and 13⋅5 per cent for peritoneal dissemination. The weighted median overall survival times were 19⋅8 months for locoregional recurrence, 15⋅0 months for liver recurrence, 30⋅4 months for lung recurrence and 14⋅1 months for peritoneal dissemination. Meta-analysis revealed that R1 (direct) resection (OR 2⋅21, 95 per cent c.i. 1⋅12 to 4⋅35), perineural invasion (OR 5⋅19, 2⋅79 to 9⋅64) and positive peritoneal lavage cytology (OR 5⋅29, 3⋅03 to 9⋅25) were significantly associated with peritoneal dissemination as initial recurrence site. Low grade of tumour differentiation was significantly associated with liver recurrence (OR 4⋅15, 1⋅71 to 10⋅07).

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Prediction scores of postoperative liver metastasis and long‐term survival of pancreatic head cancer based on the distance between the mesenteric vessels and tumor, preoperative serum carbohydrate antigen 19‐9 level, and lymph node metastasis rate

Jiang

Fan

et al. 2022

Cancer Medicine

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Background The shortest distance between the superior mesenteric artery (SMA) or superior mesenteric vein (SMV) and the tumor margin was combined with preoperative serum carbohydrate antigen (CA) 19‐9 and lymph node ratio (LNR) to evaluate joint effects on long‐term survival and liver metastasis in patients with pancreatic head cancer after radical surgery. Methods This retrospective study included 149 patients who underwent pancreaticoduodenectomy for pancreatic head cancer at Harbin Medical University Tumor Hospital from May 2011 to March 2021. The preoperative serum CA 19‐9 level and LNR were combined with the SMA or SMV distance. The joint association between long‐term survival and postoperative liver metastasis was evaluated. Results Based on the receiver operating characteristic curve of postoperative liver metastasis or long‐term survival, the optimal cut‐off values of SMV distance were 3.1 and 0.7 mm, respectively, whereas the optimal cut‐off value of SMA distance was 10.25 mm. The univariate model identified the liver metastasis score (p < 0.001) as a negative factor for postoperative liver metastasis of pancreatic head carcinoma. The SMV distance (p = 0.003), SMA distance (p < 0.001), LNR score (p < 0.001), and survival score (p < 0.001) were negatively correlated with long‐term survival after pancreatic head cancer. The multivariate model highlighted SMA distance (p < 0.001), survival score (p = 0.001), and LNR score (p < 0.001) as independent risk factors for long‐term survival in pancreatic head cancer. Conclusion Liver metastasis score may be an independent predictor of postoperative liver metastasis in patients with pancreatic head cancer. Survival and LNR scores may be independent predictors of long‐term postoperative survival in patients with pancreatic head cancer. However, the LNR score appears to improve long‐term survival.

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Pathological and Radiological Splenic Vein Involvement are Predictors of Poor Prognosis and Early Liver Metastasis After Surgery in Patients with Pancreatic Adenocarcinoma of the Body and Tail

Abstract: Pathological/radiological SV invasion were independent adverse prognostic factors associated with early liver metastasis in patients with PDAC of the body/tail. Assessment of these findings may be useful in determining optimal therapeutic options in these patients.

Cited by 21 publications

References 14 publications

Significance of radiographic splenic vessel involvement in the pancreatic ductal adenocarcinoma of the body and tail of the gland

Significance of radiographic splenic vessel involvement in the pancreatic ductal adenocarcinoma of the body and tail of the gland

Meta-analysis of recurrence pattern after resection for pancreatic cancer

Prediction scores of postoperative liver metastasis and long‐term survival of pancreatic head cancer based on the distance between the mesenteric vessels and tumor, preoperative serum carbohydrate antigen 19‐9 level, and lymph node metastasis rate

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