Duodenal Involvement is an Independent Prognostic Factor for Patients with Surgically Resected Pancreatic Ductal Adenocarcinoma

Marco Dal Molin, Amanda L. Blackford, Abdulrehman Siddiqui, Aaron Brant, Christy Cho, Neda Rezaee, Jun Yu, Jin He, Matthew J Weiss, Ralph H Hruban, Christopher Wolfgang, Michael S Goggins

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Apr 24 2017

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Adenocarcinoma
Neoplasms
Confidence Intervals
Common Bile Duct
Pancreas
Veins
Stomach
Colon
Lymph Nodes
Databases
Carcinoma
Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Duodenal Involvement is an Independent Prognostic Factor for Patients with Surgically Resected Pancreatic Ductal Adenocarcinoma. / Dal Molin, Marco; Blackford, Amanda L.; Siddiqui, Abdulrehman; Brant, Aaron; Cho, Christy; Rezaee, Neda; Yu, Jun; He, Jin; Weiss, Matthew J; Hruban, Ralph H; Wolfgang, Christopher; Goggins, Michael S.

In: Annals of Surgical Oncology, 24.04.2017, p. 1-8.

Research output: Contribution to journalArticle

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abstract = "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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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 S

PY - 2017/4/24

Y1 - 2017/4/24

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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