The Necessity of Dissection of No. 14 Lymph Nodes to Patients With Pancreatic Ductal Adenocarcinoma Based on the Embryonic Development of the Head of the Pancreas

Introduction: The impact of acute inflammation on cancer progression is still not well elucidated. Pancreatic head cancer is occasionally associated with acute cholangitis. C-reactive protein (CRP) is a biomarker that indicates presence of acute inflammation. Methods: We reviewed the patients’ data with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreaticoduodenectomy between 2004 and 2018. Results: Two hundred ninety-one patients were included. Median preoperative CRP was 0.45 mg/dL (0–18.9). Median follow-up duration was 22 months (4–152). The 1-, 3-, and 5-year overall survival (OS) rates were 76.4%, 32.2%, and 22.9%, respectively. Recurrence occurred in 168 cases (57.7%). The 1-, 3-, and 5-year disease-free survival (DFS) rates were 53.9%, 27.1%, and 21.9%, respectively. The median OS was higher in normal CRP patients (27 months) than those with elevated CRP (18 months) (log-rank 0.038). The median DFS was higher in normal CRP patients (17 months) than those with elevated CRP (9 months) (log-rank < 0.001). Predictive factors for OS included BMI, CRP, adjuvant therapy, positive lymph nodes, and microvascular invasion. Predictive factors for DFS included CRP, positive lymph nodes, and microvascular invasion. Conclusion: Preoperative CRP was an independent poor prognostic factor for OS and DFS of patients with resected PDAC.

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Reassessment of the Optimal Number of Examined Lymph Nodes in Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma

Annals of Surgery ◽

10.1097/sla.0000000000004552 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Giuseppe Malleo ◽

Laura Maggino ◽

Motaz Qadan ◽

Giovanni Marchegiani ◽

Cristina R. Ferrone ◽

...

Keyword(s):

Lymph Nodes ◽

Pancreatic Ductal Adenocarcinoma ◽

Optimal Number ◽

Ductal Adenocarcinoma

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T-Helper 1 Immune Response in Metastatic Lymph Nodes of Pancreatic Ductal Adenocarcinoma: A Marker For Prolonged Survival

Annals of Surgical Oncology ◽

10.1245/s10434-017-6237-0 ◽

2017 ◽

Vol 25 (2) ◽

pp. 475-481 ◽

Cited By ~ 6

Author(s):

Eran Nizri ◽

Neta Sternbach ◽

Shoshi Bar-David ◽

Amir Ben-Yehuda ◽

Fabian Gerstenhaber ◽

...

Keyword(s):

Immune Response ◽

Lymph Nodes ◽

Pancreatic Ductal Adenocarcinoma ◽

Prolonged Survival ◽

Ductal Adenocarcinoma ◽

T Helper ◽

T Helper 1 ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph

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Molecular targets for diagnostic and intraoperative imaging of pancreatic ductal adenocarcinoma after neoadjuvant FOLFIRINOX treatment

Scientific Reports ◽

10.1038/s41598-020-73242-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

F. A. Vuijk ◽

L. D. A. N. de Muynck ◽

L. C. Franken ◽

O. R. Busch ◽

J. W. Wilmink ◽

...

Keyword(s):

Molecular Imaging ◽

Lymph Nodes ◽

Pancreatic Ductal Adenocarcinoma ◽

Metastatic Lymph Node ◽

Imaging Techniques ◽

Intraoperative Imaging ◽

Neoadjuvant Treatment ◽

Radical Resection ◽

Ductal Adenocarcinoma ◽

Primary Tumors

Abstract Neoadjuvant systemic treatment is increasingly being integrated in the standard treatment of pancreatic ductal adenocarcinoma (PDAC) patients to improve oncological outcomes. Current available imaging techniques remain unreliable in assessing response to therapies, as they cannot distinguish between (vital) tumor tissue and therapy induced fibrosis (TIF). Consequently, resections with tumor positive margins and subsequent early post-operative recurrences occur and patients eligible for potential radical resection could be missed. To optimize patient selection and monitor results of neoadjuvant treatment, PDAC-specific diagnostic and intraoperative molecular imaging methods are required. This study aims to evaluate molecular imaging targets for PDAC after neoadjuvant FOLFIRINOX treatment. Expression of integrin αvβ6, carcinoembryonic antigen cell adhesion molecule 5 (CEACAM5), mesothelin, prostate-specific membrane antigen (PSMA), urokinase-type plasminogen activator receptor, fibroblast activating receptor, integrin α5 subunit and epidermal growth factor receptor was evaluated using immunohistochemistry. Immunoreactivity was determined using the semiquantitative H-score. Resection specimens from patients after neoadjuvant FOLFIRINOX treatment containing PDAC (n = 32), tumor associated pancreatitis (TAP) and TIF (n = 15), normal pancreas parenchyma (NPP) (n = 32) and tumor positive (n = 24) and negative (n = 56) lymph nodes were included. Integrin αvβ6, CEACAM5, mesothelin and PSMA stainings showed significantly higher expression in PDAC compared to TAP and NPP. No expression of αvβ6, CEACAM5 and mesothelin was observed in TIF. Integrin αvβ6 and CEACAM5 allow for accurate metastatic lymph node detection. Targeting integrin αvβ6, CEA, mesothelin and PSMA has the potential to distinguish vital PDAC from fibrotic tissue after neoadjuvant FOLFIRINOX treatment. Integrin αvβ6 and CEACAM5 detect primary tumors and tumor positive lymph nodes.

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Pancreatic ductal adenocarcinoma and paraaortic lymph nodes metastases: The accuracy of intraoperative frozen section

Pancreatology ◽

10.1016/j.pan.2019.05.465 ◽

2019 ◽

Vol 19 (5) ◽

pp. 710-715 ◽

Cited By ~ 1

Author(s):

Alexandre Doussot ◽

Aurélie Bouvier ◽

Nicolas Santucci ◽

Jean-Baptiste Lequeu ◽

Nicolas Cheynel ◽

...

Keyword(s):

Lymph Nodes ◽

Pancreatic Ductal Adenocarcinoma ◽

Frozen Section ◽

Ductal Adenocarcinoma ◽

Intraoperative Frozen Section ◽

Paraaortic Lymph Nodes ◽

Lymph Nodes Metastases

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Total laparoscopic versus open pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matching analysis with meta-analysis

10.21203/rs.3.rs-20225/v1 ◽

2020 ◽

Author(s):

Ke Chen ◽

Yu Pan ◽

Yi-ping Mou ◽

Chao-jie Huang ◽

Jia-fei Yan ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Lymph Nodes ◽

Pancreatic Ductal Adenocarcinoma ◽

Propensity Score Matching ◽

Meta Analysis ◽

Ductal Adenocarcinoma ◽

Survival Outcomes ◽

Low Grade ◽

Open Pancreaticoduodenectomy

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer mortality worldwide. Total laparoscopic pancreaticoduodenectomy (TLPD) have been used in the treatment of benign and low-grade diseases on the pancreatic head. It is necessary to expand the current knowledge on the feasibility and safety of TLPD for PDAC treatment. We aimed to assess the surgical and oncological outcomes of TLPD for patients with PDAC by comparing them with open pancreaticoduodenectomy (OPD). Methods Data regarding patients who underwent pancreaticoduodenectomy for PDAC treatment from January 2013 to January 2019 in our hospital were obtained. Baseline characteristics, intraoperative effects, postoperative recoveries, and survival outcomes were compared. To overcome selection bias, we performed a 1:1 match using propensity score matching (PSM) between TLPD and OPD. We also conducted a systematic review and meta-analysis. Results The original cohort included 276 patients (TLPD; 98 patients, OPD; 178 patients). After PSM, there were 89 patients in each group and the patient demographics were well matched. Of the 98 patients who underwent TLPD, 8 (8.2%) required conversions to laparotomies. Compared to OPD, TLPD could be performed with longer operative times, had less blood loss, and had lower overall morbidities. Regarding oncological and survival outcomes, there were no significant differences in tumor size, R0 resection rates and tumor stages between groups. However, TLPD had an advantage over OPD in terms of retrieved lymph nodes (21.9 ± 6.6 vs. 18.9 ± 5.4, p < 0.01). There were no statistically signiﬁcant differences between the groups in recurrence patterns, and the 3-year recurrence-free and overall survival rates were comparable between the two groups. Meta-analysis further confirmed that the TLPD were associated with longer operative times, less blood loss, shorter hospitalizations, lower morbidities, and a greater number of retrieved lymph nodes. Conclusions TLPD are feasible and oncologically safe procedures for PDAC treatments. Postoperative outcomes and long-term survival after TLPD are superior, or not inferior, to OPD, and could be a promising alternative to open surgery for PDAC treatments. Our findings should be further evaluated by multicenter or randomized controlled trials.

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A Prognostic Nomogram for Disease-Specific Survival in Patients with Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas Following Pancreaticoduodenectomy

Medical Science Monitor ◽

10.12659/msm.909649 ◽

2018 ◽

Vol 24 ◽

pp. 6313-6321 ◽

Cited By ~ 9

Author(s):

Huang-bao Li ◽

Jun Zhou ◽

Feng-qing Zhao

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Ductal Adenocarcinoma ◽

Disease Specific Survival ◽

Head Of The Pancreas ◽

Disease Specific

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Development and validation of a Nomogram for predicting the Overall Survival of Patients With Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas

10.21203/rs.3.rs-258185/v1 ◽

2021 ◽

Author(s):

Zhilong Liu ◽

Haohui Yu ◽

Mingrong Cao ◽

Jiexing Li ◽

Yulin Huang ◽

...

Keyword(s):

Overall Survival ◽

Pancreatic Ductal Adenocarcinoma ◽

Staging System ◽

The United States ◽

Ductal Adenocarcinoma ◽

Seer Database ◽

Training Set ◽

Head Of The Pancreas ◽

Ajcc Staging System ◽

Ajcc Staging

Abstract Background: The purpose of this study is to develop and validate a nomogram to predict the overall survival (OS) of patients with Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas (PDAC-HP).Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we collected patients with PDAC-HP in the United States between 2004 and 2015. Patients were randomly divided into training set and validating set at a ratio of 7:3. The training set is used to develop a nomogram for predicting OS. These indicators such as the C index, the area under curve (AUC) of the receiver operating characteristic (ROC), calibration plots and the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) were used to evaluate the prediction accuracy of the nomogram.Results: A total of 33,893 patients with PDAC-HP over 20 years old were diagnosed between 2004 and 2015 were collected from the SEER database. Using multivariable Cox regression analysis, we identified eight risk factors that were associated with OS, such as age at diagnosis, sex, marital status at diagnosis, race, AJCC staging, surgery, radiotherapy and chemotherapy. A nomogram was constructed based on these variables. Compared with the AJCC staging system, the nomogram has a better C index and AUC in the training set and validatiing set. The calibration plots indicated that the nomogram was able to accurately predict the OS of patients with PDAC-HP at 1, 3, and 5 years.Conclusions: We developed and validated a nomogram, and predicted the OS of patients with PDAC-HP at 1, 3, and 5 years. Compared with the AJCC staging system, the nomogram we constructed has better performance. It shows that our nomogram could be served as an effective tool for prognostic evaluation of patients with PDAC-HP.

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