Radiological tumour invasion of splenic artery or vein in patients with pancreatic body or tail adenocarcinoma and effect on recurrence and survival

Abstract

Background Major vessel invasion is an important factor for determining the surgical approach and long-term prognosis for patients with pancreatic head cancer. However, clinical implications of vessel invasion have seldom been reported in pancreatic body or tail cancer. This study aimed to evaluate the clinical relevance of splenic vessel invasion with pancreatic body or tail cancer compared with no invasion and investigate prognostic factors. Methods This study enrolled patients who underwent upfront distal pancreatectomy from 2005 to 2018. The circular degree of splenic vessel invasion was investigated and categorized into three groups (group 1, no invasion; group 2, 0–180°; group 3, 180° or more). Clinicopathological variables and perioperative and survival outcomes were evaluated, and multivariable Cox proportional analysis was performed to evaluate prognostic factors. Results Among 249 enrolled patients, tumour size was larger in patients with splenic vessel invasion (3.9 versus 2.9 cm, P = 0.001), but the number of metastatic lymph nodes was comparable to that in patients with no vessel invasion (1.7 versus 1.4, P = 0.241). The 5-year overall survival rates differed significantly between the three groups (group 1, 38.4 per cent; group 2, 16.8 per cent; group 3, 9.7 per cent, P < 0.001). Patients with both splenic artery and vein invasion had lower 5-year overall survival rates than those with one vessel (7.5 versus 20.2 per cent, P = 0.021). Cox proportional analysis revealed adjuvant treatment, R0 resection and splenic artery invasion as independent prognostic factors for adverse outcomes in pancreatic body or tail cancer. Conclusion Splenic vessel invasion was associated with higher recurrence and lower overall survival in pancreatic body or tail cancers suggesting a need for a neoadjuvant approach.

Impact of radiological and pathological splenic vein involvement in patients with resectable pancreatic body or tail cancer

“…Recently, ve studies suggested that radiological splenic vessel involvement can be a negative prognostic indicator. Among these, four studies found that radiological SpA involvement is a signi cant independent predictor of poor prognosis [7,8,10,11]. Additionally, two studies identi ed radiological SpV involvement as an independent poor prognostic factor [15,16].…”

“…However, in pancreatic body or tail cancer, the involvement of these vessels is not surgically signi cant but is a poor prognostic factor in oncology, along with lymph node metastasis, tumour size, and tumour differentiation [4][5][6]. Although there have been several studies on splenic vessel involvement [5,[7][8][9], especially on SpA involvement [10][11][12][13][14], few studies have focused on SpV involvement [15,16].…”

Impact of radiologic splenic vessel invasion in resectable left-sided pancreatic ductal adenocarcinoma: predictor of early systemic recurrence following upfront surgery

“…Although recent studies reported that pathological infiltration of SV is associated with a worse prognosis ( 31 - 33 ), resectable left-sided PDAC with SVs invasion alone is considered “anatomically” resectable disease. However, recent studies reported that radiologic SVs invasion is associated with a poor prognosis, suggesting a need for NAT ( 34 - 36 ). The present study also showed a poor prognostic impact of radiologic SVs invasion in anatomically resectable left-sided PDAC.…”

The Trinity: Interplay among Cancer Cells, Fibroblasts, and Immune Cells in Pancreatic Cancer and Implication of CD8+ T Cell-Orientated Therapy

“…Pancreatic cancer is a deadly malignancy around the world according to the latest global reports [1,2] and is expected to be the second leading cause of cancer-related death in 2030 [2]. Surgery [3], radiotherapy [4], chemotherapy [5,6], and immunotherapy [7,8] are available for pancreatic cancer treatment; however, recurrence and metastasis occur [9][10][11][12][13][14][15] frequently after treatment [16]. Therefore, the identification of additional molecular targets and development of novel therapeutic strategies are urgently needed.…”