Pathomorphological and histological prognostic factors in curatively resected ductal adenocarcinoma of the pancreas

Abstract

The fate of patients with potentially resectable carcinomas is not only determined by the pTNM tumor stage, but also possibly by tumor-biological factors. The aim of this study was to identify these prognostic factors in patients undergoing primary curative (R0) resection. The study retrospectively analyzed 113 patients with ductal adenocarcinoma who were operated on between 1986 and 1995. R0 resection was able to be performed in 93 patients. Lymph node metastases were found in 73%. The rates of lymph vessel and perineural invasion were 83.5% and 45%, respectively. Among the 25 carcinomas without lymph node metastases, 64% already had lymph vessel invasion and 48% had perineural invasion. The cumulative 5-year survival rate of the 91 surviving patients analyzed was 10.5%. Depending on the tumor stage we found a significant difference in 5-year survival rates between patients without lymph node metastases (26.5%) and those with lymph node involvement (5%) (P = 0.008). A multivariate analysis only identified lymph vessel invasion (L0/1), tumor size (< or = or < or =2 cm), and tumor grading (G) to have significant and independent prognostic value. Lymph vessel invasion, tumor size, and tumor grading proved to be independent factors determining long-term prognosis.

The role of MRI in pancreatic cancer

“…Poorly differentiated histology (found in approximately one-third of cases), positive resection margins (present in up to 30% of cases) and tumour size greater than 2-3 cm are all associated with worse prognosis. In large surgical series, over 70% of patients in whom curative resection was carried out were found to have malignant invasion of local lymph nodes [8,9]. Even in those patients with negative nodes, invasion of the lymphatic vessels is commonly seen.…”

Impact of tumor size on survival outcome of pancreatic carcinoma following pancreatic resection: A systematic review and meta-analysis

“…8,[30][31][32] Finally, 18 articles were included after reading the full papers (Table 1). 4,[15][16][17][18][19][33][34][35][36][37][38][39][40][41][42][43][44] …”

“…Tumor diameter with 3cm and 4 cm cut-offs are not specified in the staging and thus causing conflicts about selection of the tumor size cut-off in defining the tumor stage. Many studies have favored the AJCC tumor staging cut-off of 2 cm, [14][15][16] whereas there are studies [17][18][19] which reports the indication for reconsideration of the tumor stage cut-off, to provide more precise reference for staging and predicting survival outcome. Moreover, the impact of tumor size on survival outcome also remains controversial.…”

Prognostic Factors in Pancreatic Cancer: The Role of Perineural, Vascular and Lymphatic Invasion and of Ca19-9

“…Several studies examined the impact of perineural invasion on survival in resected pancreatic adenocarcinoma, reporting infiltration as a significant prognostic variable. In fact perineural invasion was associated with poor survival following pancreaticduodenectomy [9][10][11][12][13]. Again, several studies showed that blood vessel invasion was associated with poor outcome in patients with resected pancreatic cancer [11,14,15].…”