Surgical management of periampullary adenocarcinoma: defining an optimal prognostic lymph node stratification schema

He, Chaobin; Mao, Yijun; Wang, Jun; Huang, Xin; Lin, Xiaojun; Li, Shengping

doi:10.7150/jca.24109

Cited by 20 publications

(22 citation statements)

References 47 publications

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“…In addition, our study showed that, compared with OS, tumor size weighted more in predicting CSS which was mainly influenced by the inherent characteristics of tumor itself. Tumor grade and tumor site were also proven to be prognostic factors and were included in the stage system in this study, which was in accordance with other similar studies (27,31). Our analysis supported the prognostic significance of tumor site in predicting OS and indicated that LAPC patients occurring in the head or overlapping sites of the pancreas had a decreasing probability of OS compared with diseases occurring in the body and tail of pancreas.…”

Section: Discussionsupporting

confidence: 91%

A Novel Prediction Tool Based on Large Cohorts to Determine the Cancer-Specific Survival Probability of Patients With Locally Advanced Pancreatic Cancer After Irreversible Electroporation Treatment

Huang

Lin

et al. 2020

Front. Oncol.

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Irreversible electroporation (IRE) is a novel method which was especially suitable for the treatment of locally advanced pancreatic cancer (LAPC). The purpose of this study was to evaluate probabilities of overall survival (OS) and cancer-specific survival (CSS) in patients with LAPC after IRE treatment and to construct nomograms to predict survival for these patients. Data of patients were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database and medical records of Sun Yat-sen University Cancer Center (SYSUCC). A total of 312 LAPC patients after IRE treatment were included into this study. The 3-year cumulative incidence of cancer-specific mortality for patients with LAPC after IRE treatment was 74.3%. Nomograms for predicting probabilities of OS, CSS, and non-cancer-specific survival (NCSS) were built and calibrated with the concordance index (C-index) and the area under receiver operating characteristic (ROC) curve (AUC). The established nomograms were well-calibrated, with C-indexes of 0.782 for OS prediction, 0.729 for CSS prediction, and 0.730 for NCSS prediction. Compared with the TNM stage system, the established nomograms displayed higher values of AUC and showed better discriminatory power for predicting OS, CSS, and NCSS. These nomograms were well-calibrated and could serve to guide management of LAPC patients after IRE treatment.

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Section: Discussionsupporting

confidence: 91%

A Novel Prediction Tool Based on Large Cohorts to Determine the Cancer-Specific Survival Probability of Patients With Locally Advanced Pancreatic Cancer After Irreversible Electroporation Treatment

Huang

Lin

et al. 2020

Front. Oncol.

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“…The follow-up procedure was performed in accordance with previous publications and recommendations [21, 22]. OS was defined as the duration from treatment until death or the last follow-up.…”

Section: Methodsmentioning

confidence: 99%

Immunomodulatory Effect after Irreversible Electroporation in Patients with Locally Advanced Pancreatic Cancer

Wang

Sun

et al. 2019

Journal of Oncology

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Purpose. Irreversible electroporation (IRE) has been demonstrated to be a safe and effective method for locally advanced pancreatic cancer (LAPC). The aim of this study was to evaluate the immunomodulatory effect after IRE and to evaluate the prognostic value of variations of the immune parameters in LAPC patients after IRE. Methods. Peripheral blood samples of 34 patients were obtained preoperatively and on the third day (D3) and seventh day (D7) after IRE, respectively. The phenotypes of lymphocytes were analyzed by flow cytometry, and dynamic changes of serum levels of cytokines, complement, and immunoglobulin were assayed by enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curve and concordance index (C-index) were used to compare the survival predictive ability. Results. There was a transitory decrease followed by a steady increase for CD4+ T cell, CD8+ T cell, NK cell, IL-2, C3, C4, and IgG while a reverse trend was detected for Treg cell, IL-6, and IL10 after IRE. The alteration of CD8+ T cell between D3 and D7 was identified as a prognostic factor for both overall survival (OS) and progression-free survival (PFS). The values of ROC curve (AUC) and C-indexes of the alteration of CD8+ T cell for OS and PFS were 0.816 and 0.773 and 0.816 and 0.639, respectively, which were larger than those of other immune or inflammation-based indexes. Conclusions. This study presented the first evidence of IRE-based immunomodulatory in patients with LAPC. The alteration of CD8+ T cell between D3 and D7 showed relatively good performance and could be used as an effective tool for prognostic evaluation for LAPC patients after IRE.

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“…The periampullary region is a complex region which is composed of distinct anatomical structures: the head of the pancreas, distal common bile duct, second portion of the duodenum and ampulla of Vater. Periampullary adenocarcinomas are currently classified by their anatomic location of origin according to the seventh edition of the American Joint Committee on Cancer staging system . They can be divided into two subgroups based on morphology, either intestinal type (I‐type) or pancreatobiliary type (PB‐type), and there is increasing evidence that morphology is a more important determinant of survival than anatomical origin .…”

Section: Introductionmentioning

confidence: 99%

“…Periampullary adenocarcinomas are currently classified by their anatomic location of origin according to the seventh edition of the American Joint Committee on Cancer staging system. 1 They can be divided into two subgroups based on morphology, either intestinal type (I-type) or pancreatobiliary type (PB-type), and there is increasing evidence that morphology is a more important determinant of survival than anatomical origin. [2][3][4][5] Survival rates remain dismally low for this group of patients, with 5-year overall survival (OS) rates of around 6%, 6 partly due to late presentation of the disease, but also because both conventional and targeted therapies have shown limited efficacy.…”

Section: Introductionmentioning

confidence: 99%

Quantitative, qualitative and spatial analysis of lymphocyte infiltration in periampullary and pancreatic adenocarcinoma

Lundgren

Elebro

Heby

et al. 2020

Intl Journal of Cancer

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Immunotherapeutic modalities are currently revolutionizing cancer treatment. In pancreatic cancer, however, early clinical trials have been disappointing. The optimization of immunotherapeutic strategies requires better understanding of the inflammatory tumor microenvironment. Therefore, the aim of our study was to perform a detailed in situ description of lymphocyte infiltration patterns in resected pancreatic and other periampullary cancers. Multiplexed immunofluorescence imaging was applied to tissue microarrays with tumors from a cohort of 175 patients with resected periampullary adenocarcinoma. A panel of immune cell markers including CD4, CD8α, FoxP3, CD20, CD45RO and pan-cytokeratin was applied to allow for simultaneous spatial analysis of multiple lymphocyte populations. The majority of lymphocyte populations were significantly more abundant in intestinal (I-type) compared to pancreatobiliary (PB-type) tumors. Hierarchical cluster analysis revealed several immune cell signatures of potential clinical relevance. Notably, in the stromal compartment of PB-type tumors, high infiltration of B cells, CD8α + CD45RO + and single-positive CD4 + T cells, but low levels of FoxP3 + CD45RO high and single-positive CD8α + T cells were associated with improved overall survival (OS). The study also defined prognostic relevant topographical patterns of lymphocytic infiltration, in particular proximity of CD8α + cells to cancer cells. Moreover, the presence of lymphocytes with potential T-helper capacities (CD4 + ) in the nearest vicinity to CD8α + cells was associated with a prolonged OS. Our data demonstrate that the composition and clinical impact of immune infiltrates in periampullary adenocarcinoma differ by morphological type as well as localization. Furthermore, spatial in situ analysis identified potential immunological mechanisms of prognostic significance.Additional Supporting Information may be found in the online version of this article.

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Surgical management of periampullary adenocarcinoma: defining an optimal prognostic lymph node stratification schema

Cited by 20 publications

References 47 publications

A Novel Prediction Tool Based on Large Cohorts to Determine the Cancer-Specific Survival Probability of Patients With Locally Advanced Pancreatic Cancer After Irreversible Electroporation Treatment

A Novel Prediction Tool Based on Large Cohorts to Determine the Cancer-Specific Survival Probability of Patients With Locally Advanced Pancreatic Cancer After Irreversible Electroporation Treatment

Immunomodulatory Effect after Irreversible Electroporation in Patients with Locally Advanced Pancreatic Cancer

Quantitative, qualitative and spatial analysis of lymphocyte infiltration in periampullary and pancreatic adenocarcinoma

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