TY - JOUR
T1 - Duodenal Involvement is an Independent Prognostic Factor for Patients with Surgically Resected Pancreatic Ductal Adenocarcinoma
AU - Dal Molin, Marco
AU - Blackford, Amanda L.
AU - Siddiqui, Abdulrehman
AU - Brant, Aaron
AU - Cho, Christy
AU - Rezaee, Neda
AU - Yu, Jun
AU - He, Jin
AU - Weiss, Matthew J
AU - Hruban, Ralph H.
AU - Wolfgang, Christopher
AU - Goggins, Michael
N1 - Funding Information:
ACKNOWLEDGMENT This work was supported by NIH Grants (CA62924 and R01CA176828), the Rolfe Pancreatic Cancer Foundation, and Susan Wojcicki and Dennis Troper.
Publisher Copyright:
© 2017, Society of Surgical Oncology.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background: The current staging system for pancreatic ductal adenocarcinoma (PDAC) includes information about size and local extension of the primary tumor (T stage). The value of incorporating any local tumor extension into pancreatic staging systems has been questioned because it often is difficult to evaluate tumor extension to the peri-pancreatic soft tissues and because most carcinomas of the head of the pancreas infiltrate the intra-pancreatic common bile duct. This study sought to evaluate the prognostic implications of having PDAC with local tumor extension. Methods: A single-institution, prospectively collected database of 1128 patients who underwent surgical resection for PDAC was queried to examine the prognostic significance of extra-pancreatic tumor involvement (“no involvement,” “duodenal involvement,” and “extensive involvement”; e.g., gastric, colon or major vein involvement). Results: The median overall survival for the patients without extra-pancreatic involvement was 26 months versus 19 months for the patients with duodenal involvement and 16 months for the patients with extensive involvement (p < 0.001). In the multivariable analysis, duodenal and extensive involvement independently predicted increased risk of death compared with no involvement (hazard ratio [HR] 1.30; 95% confidence interval [CI] 1.08–1.57 and 1.78; 95% CI 1.25–2.55, respectively). A multivariable model combining duodenal and extensive extra-pancreatic involvement, tumor grade, lymph node ratio, and other prognostic features had the highest c-index (0.67). Conclusions: Inclusion of duodenal involvement in the staging of PDAC adds independent prognostic information.
AB - Background: The current staging system for pancreatic ductal adenocarcinoma (PDAC) includes information about size and local extension of the primary tumor (T stage). The value of incorporating any local tumor extension into pancreatic staging systems has been questioned because it often is difficult to evaluate tumor extension to the peri-pancreatic soft tissues and because most carcinomas of the head of the pancreas infiltrate the intra-pancreatic common bile duct. This study sought to evaluate the prognostic implications of having PDAC with local tumor extension. Methods: A single-institution, prospectively collected database of 1128 patients who underwent surgical resection for PDAC was queried to examine the prognostic significance of extra-pancreatic tumor involvement (“no involvement,” “duodenal involvement,” and “extensive involvement”; e.g., gastric, colon or major vein involvement). Results: The median overall survival for the patients without extra-pancreatic involvement was 26 months versus 19 months for the patients with duodenal involvement and 16 months for the patients with extensive involvement (p < 0.001). In the multivariable analysis, duodenal and extensive involvement independently predicted increased risk of death compared with no involvement (hazard ratio [HR] 1.30; 95% confidence interval [CI] 1.08–1.57 and 1.78; 95% CI 1.25–2.55, respectively). A multivariable model combining duodenal and extensive extra-pancreatic involvement, tumor grade, lymph node ratio, and other prognostic features had the highest c-index (0.67). Conclusions: Inclusion of duodenal involvement in the staging of PDAC adds independent prognostic information.
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U2 - 10.1245/s10434-017-5864-9
DO - 10.1245/s10434-017-5864-9
M3 - Article
C2 - 28439733
AN - SCOPUS:85018797594
SN - 1068-9265
VL - 24
SP - 2379
EP - 2386
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 8
ER -