Superior Prognostic Importance of Perineural Invasion vs. Lymph Node Involvement After Curative Resection of Duodenal Adenocarcinoma

Cecchini, S.; Correa‐Gallego, Camilo; Desphande, Vikram; Ligorio, Matteo; Dursun, Abdulmetin; Wargo, Jennifer A.; Castillo, Carlos Fernández del; Warshaw, Andrew L.; Ferrone, Cristina R.

doi:10.1007/s11605-011-1704-6

Cited by 47 publications

(42 citation statements)

References 30 publications

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“…Morbidity and mortality rates associated with surgical treatment for resectable duodenal cancer are high. Reported morbidity rates are around 40 per cent, and mortality rates range between 0 and 8·5 per cent ( Table S3 , supporting information).…”

Section: Discussionmentioning

confidence: 99%

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Outcome after surgical resection for duodenal adenocarcinoma in the UK

Solaini

Jamieson

Metcalfe

et al. 2015

British Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

“…Surgical resection offers the only chance of cure. There are few published studies on outcomes after surgery owing to the rarity of this condition. These studies are characterized by a limited number of patients and long study periods, resulting in conflicting reported outcomes.…”

Section: Introductionmentioning

confidence: 99%

Outcome after surgical resection for duodenal adenocarcinoma in the UK

Solaini

Jamieson

Metcalfe

et al. 2015

British Journal of Surgery

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“…However, given the low prevalence of this disease in the general population and the limited number of clinical studies, there is no consensus as to the most effective treatment strategy. Conflicting information exists on the required extent of resection of duodenal adenocarcinoma [3, 4]. Some have suggested pancreaticoduodenectomy for all duodenal adenocarcinoma patients, regardless of TNM (tumor-node-metastasis) stage and location, to ensure that there is a tumor-free (R0) margin and adequate regional lymphadenectomy.…”

Section: Introductionmentioning

confidence: 99%

“…Others have advocated the use of segmental resection for appropriate patients [3]. In the last decade, different studies have evaluated the correlations between clinical, pathological, and treatment variables in order to identify specific prognostic factors associated with survival [4–9]. Identifying the prognostic factors is of great significance for the comprehensive understanding of the characteristics of this disease and has an important guiding meaning for the disease prevention and treatment.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China

Jiang

Huang

Chen

et al. 2016

BioMed Research International

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Aim. To evaluate the clinical risk factors influencing overall survival of patients with duodenal adenocarcinoma after potentially curative resection. Methods. A series of 201 patients with primary duodenal adenocarcinoma who underwent surgery from 1999 to 2014 at Chinese Medical Academic Cancer Hospital were studied by retrospective chart review and subsequent telephone follow-up. Results. Resectional surgery was performed in 138 of the 201 patients to attempt curative treatment, while 63 patients were treated with palliative surgery. Median survival of patients who underwent resectional operation was 57 months, whereas that of patients who had palliative surgery was shorter, 7 months (p < 0.001). For patients who underwent radical resection, the overall 1-, 3-, and 5-year survival rates were 87.3, 59.1, and 44.1%, respectively. Multivariate Cox regression analysis revealed that lymph node metastasis (HR 31.76, 2.14 to 470.8; p = 0.012) and vascular invasion (HR 3.75, 1.24 to 11.38; p = 0.020) were independent prognostic factors negatively associated with survival in patients undergoing curative resection. There was no survival difference between the groups treated by the pancreaticoduodenectomy (n = 20) and limited resection (n = 10) for early-stage duodenal adenocarcinoma (p = 0.704). Conclusions. Duodenal adenocarcinoma is a rare disease. Curative resection is the best treatment for appropriate patients. Lymph node metastases and vascular invasion are negative prognostic factors.

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“…Both perineural infiltration and lymphovascular invasion in pancreaticoduodenectomy specimens were found to be associated with a decreased 5-year survival [1]. Perineural invasion alone has also been shown to be a strong predictor of survival in patients with periampullary, duodenal, and ampullary adenocarcinomas [2–4]. Talamini et al identified a higher resectability rate and better prognosis in patients with ampulla of Vater tumors and emphasized that the LN status likely influenced survival outcomes [5].…”

Section: Introductionmentioning

confidence: 99%

The Association between Survival and the Pathologic Features of Periampullary Tumors Varies over Time

et al. 2014

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Introduction. Several histopathologic features of periampullary tumors have been shown to be correlated with prognosis. We evaluated their association with mortality at multiple time points. Methods. A retrospective chart review identified 207 patients with periampullary adenocarcinomas who underwent pancreaticoduodenectomy between January 1, 2001 and December 31, 2009. Clinicopathologic features were assessed, and the data were analyzed using univariate and multivariate methods. Results. In univariate analysis, perineural invasion had a strong association with 1-year mortality (OR 3.03, CI 1.42–6.47), and one lymph node (LN) increase in the LN ratio (LNR) equated with a 5-fold increase in mortality. In contrast, LN status (OR 6.42, CI 3.32–12.41) and perineural invasion (OR 5.44, CI 2.81–10.52) had the strongest associations with mortality at 3 years. Using Cox proportional hazards, perineural invasion (HR 2.61, CI 1.77–3.85) and LN status (HR 2.69, CI 1.84–3.95) had robust associations with overall mortality. Recursive partitioning analysis identified LNR as the most important risk factor for mortality at 1 and 3 years. Conclusions. Overall mortality was closely related to the LNR within the first year, while longer follow-up periods demonstrated a stronger association with perineural invasion and overall LN status. Therefore, the current staging for periampullary tumors may need to be updated to include the LNR.

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Superior Prognostic Importance of Perineural Invasion vs. Lymph Node Involvement After Curative Resection of Duodenal Adenocarcinoma

Abstract: Perineural invasion is a stronger predictor for recurrence and survival than tumor size, depth of infiltration, lymph node involvement, and type of resection in patients with duodenal adenocarcinoma.

Cited by 47 publications

References 30 publications

Outcome after surgical resection for duodenal adenocarcinoma in the UK

Outcome after surgical resection for duodenal adenocarcinoma in the UK

Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China

The Association between Survival and the Pathologic Features of Periampullary Tumors Varies over Time

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