Splenic-vasculature involvement is associated with poor prognosis in resected distal pancreatic cancer

Author:

Yin Feng1,Saad Mohammed2,Lin Jingmei2,Jackson Christopher R3,Ren Bing3,Lawson Cynthia4ORCID,Karamchandani Dipti M4,Bernabeu Belen Quereda5,Jiang Wei5,Dhir Teena5,Zheng Richard5,Schultz Christopher W5,Zhang Dongwei6,Thomas Courtney L7,Zhang Xuchen7,Lai Jinping8,Schild Michael9,Zhang Xuefeng10,Xie Hao11,Liu Xiuli12

Affiliation:

1. Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA

2. Department of Pathology, Indiana University, Indianapolis, IN, USA

3. Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

4. Department of Pathology, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, PA, USA

5. Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

6. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA

7. Department of Pathology, Yale University, New Haven, CT, USA

8. Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA

9. Department of Pathology, Duke University, Durham, NC, USA

10. Department of Pathology, Cleveland Clinic, Cleveland, OH, USA

11. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA

12. Department of Pathology, Immunology and Lab Medicine, University of Florida, Gainesville, FL, USA

Abstract

Abstract Background Distal pancreatic carcinoma is one of the most lethal cancers largely due to its high incidence of distant metastasis. This study aims to assess the prognostic value of splenic-vasculature involvement in resected distal pancreatic carcinoma. Methods In this retrospective study, we collected the clinicopathologic information of 454 patients with pancreatic cancer and performed univariate and multivariate analyses to identify factors associated with progression-free survival (PFS) and overall survival (OS), with an emphasis on the prognostic value of splenic-artery and -vein involvement. Results Univariate analysis revealed that larger tumor size, non-intraductal papillary mucinous neoplasm (non-IPMN)-associated adenocarcinoma, poor differentiation, stage pT3, nodal metastasis, lymphovascular invasion, perineural invasion, and pathologic and radiographic evidence of splenic-vein invasion were significantly associated with shorter PFS and OS (all P < 0.05). Multivariate analysis confirmed non-IPMN-associated adenocarcinoma, stage pT3, stage pN1–2, and post-operative adjuvant chemotherapy as independent risk factors for both PFS and OS, and larger tumor size and radiographic evidence of splenic-artery invasion as predictors of PFS only. Conclusion Guidelines should be developed for a uniform approach with regard to the examination and reporting of the status of the splenic vasculature when dealing with distal-pancreatic-cancer specimens.

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology

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