The Intraductal Carcinoma Component Is a Significant Prognostic Parameter in Patients with Invasive Ductal Carcinoma of the Pancreas

Abstract

We have sometimes encountered invasive ductal carcinomas (IDCs) of the pancreas containing intraductal carcinoma components in the intra-and/or extra-tumor area. The purpose of this study was to investigate whether intraductal carcinoma components would be useful for predicting the outcome of IDC patients. Forty-seven surgically treated IDCs were examined, and all histological tumor sections were stained with Elastica to accurately confirm intraductal carcinoma components. Well-known clinicopathological parameters that exhibited a significant correlation in the univariate analyses for predicting disease-free survival (DFS) and overall survival (OS) were entered into the Cox proportional hazard multivariate analysis. Since the lowest P-value predicting DFS or OS periods was observed in IDCs with more than 10% intraductal carcinoma components and those with 10% or less intraductal carcinoma components (P = = = =0.028 and P = = = =0.019), we established the cutoff value of intraductal carcinoma components at 10%. In the multivariate analyses for DFS and OS, the presence of more than 10% intraductal carcinoma components showed a marginally significant increase in the hazard rate (HR) of tumor recurrence (P = = = =0.067) and significantly increased the HR of mortality (P = = = =0.040). The present study demonstrated that IDCs with more than 10% intraductal carcinoma components were associated with a significantly better patient outcome than those with 10% or less intraductal carcinoma components.Key words: Ductal carcinoma -Pancreas -Intraductal component -Prognosis -HistologyThe major histological type of pancreatic tumors is invasive ductal carcinoma (IDC), and the outcome of patients with IDCs is very poor. 1) However, we have sometimes encountered IDCs containing intraductal carcinoma components and exhibiting papillary or low-papillary features resembling the noninvasive components of invasive papillary-mucinous carcinoma of the pancreas.2, 3) Invasive papillary-mucinous carcinomas have ample intraductal carcinoma components, and the clinical course of patients with invasive papillary-mucinous carcinoma is better than that of patients with IDC. In breast cancer, a tendency was observed for decreased nodal metastases and a more favorable prognosis when the intraductal component in the tumor was relatively more abundant.4) This suggested to us that the rate of intraductal carcinoma components in IDCs plays an important role in the outcome for patients with IDC of the pancreas.The purpose of this study was to investigate whether there is a cutoff value for the area of intraductal carcinoma components that would be useful for predicting the outcome in IDC patients. In addition, a comparative study was performed between patients with IDCs with intraductal carcinoma components at or above the cutoff value and patients with invasive papillary-mucinous carcinoma, which is associated with a better clinical course than IDC, 5,6) to clarify whether the clinical course of the former is similar to that of the latter. The res...

An intraductal papillary component is associated with prolonged survival after hepatic resection for intrahepatic cholangiocarcinoma

“…Similar clinicopathological findings have been reported in intraductal papillary–mucinous tumours of the pancreas; such tumours with invasive behaviour are associated a better outcome than invasive ductal carcinoma of the pancreas29–31. Moreover, favourable outcomes for patients with invasive ductal carcinoma of the pancreas32–34 and breast cancer35 have been demonstrated when intraductal carcinoma components are identified. It is likely that some ICCs of the mass‐forming or periductal–infiltrating type with IDPCC might be derived from the intraductal growth‐type tumour and be associated with a favourable outcome.…”

Biologically Different Subgroups of Invasive Ductal Carcinoma of the Pancreas

“…It was previously reported that the presence of ICCs in IDCP was a significant good prognostic parameter for patients with IDCP after surgical resection and the survival time of patients with ICC-rich IDCP was almost similar to that of those with ICs from IPMNs (3,13,(22)(23)(24)(25). Furthermore, some studies (24) referred to the morphological similarities of intraductal carcinoma components between IDCP accompanied with ICCs and IPMN and the difficulties in distinguishing between ICC-rich IDCP and ICs from IPMNs (3,4,13,25). This study clearly showed that the frequencies of Dpc4 protein expression of ICC-rich IDCP were significantly higher than that of ICC-poor IDCP in invasive and intraductal carcinoma area and were similar to that in ICs from IPMN.…”

“…We previously reported that among IDCP, about half of them were accompanied by abundant intraductal carcinoma components, corresponding to PanIN-3 of the PanIN classification (containing Ն10% than intraductal carcinoma area among the entire tumorous area; i.e., ICC rich) and were expected to have a more favorable prognosis than the other tumors that were poor in accompanying ICCs (containing Ͻ10% intraductal carcinoma area among the entire tumorous area; i.e., ICC poor; Ref. 3). Fukushima et al (13) also reported that a longer survival was expected for patients whose IDCP had ICCs compared with those without.…”

“…By careful histological analysis, some authors reported that among IDCP, about half of the cases were accompanied by intraductal proliferative lesions, which are classified under the pancreatic intraepithelial neoplasm (PanIN) classification (3)(4)(5). Many morphological and genetical investigations revealed that those PanINs were precursor lesions of IDCP (1, 4 -12).…”

Pathological complete response (pCR) with or without the residual intraductal carcinoma component following preoperative treatment for pancreatic cancer: Revisiting the definition of “pCR” from the prognostic standpoint

“…Considerations of the mechanisms of the presence or absence of residual CIS in pCR cases are of interest. Some authors reported that approximately half of PDAC cases were accompanied by a rich intraductal component, whereas the remaining half of PDAC cases were not . In this context, the pCR cases with absence of CIS might originate from tumors that were not originally accompanied by CIS before preoperative treatment, showing complete response in the invasive component to preoperative treatment.…”