Abstract
Introduction
Positive cytology from peritoneal washings obtained prior to potential resection of pancreatic cancer is associated with grim prognosis, equivalent to M1 disease. We examine our experience with pancreatic cancer patients who underwent pre-resection lavage in an attempt to predict who would have malignant cells on peritoneal cytology.
Methods
We conducted a retrospective review of patients undergoing pancreatectomy for pancreatic adenocarcinoma at a tertiary care institution from 1995 to 2019 and had pre-resection lavage performed. Demographic and clinicopathologic data were collected. Logistic regression models were used to identify predictors of positive cytology.
Results
Three hundred ninety-nine patients underwent pancreatic resection and had lavage performed. Forty-three (10.8%) had positive peritoneal cytology. Those with positive cytology had higher median Ca19-9 value than those with negative cytology at diagnosis (368.5 vs 200 U/mL, p = 0.007) and after neoadjuvant therapy (100.3 vs 43 U/mL, p = 0.013). After controlling for preoperative therapy received, an initial Ca19-9 greater than 1220 U/mL (OR 2.72, 95% CI 1.07–6.89, p = 0.035), locally advanced disease (OR 4.86, 95% CI 1.31–18.09, p = 0.018), and BMI ≥ 25 kg/m2 (OR 2.67, 95% CI 1.04–6.97, p = 0.042) were associated with positive cytology in multivariate logistic regression model. The associated ROC curve had an AUC of 0.7507, suggesting adequate discrimination of those with positive peritoneal cytology.
Conclusion
Diagnostic laparoscopy remains an important adjunct to the workup, diagnosis, and staging of pancreatic adenocarcinoma. Patients with locally advanced disease, significantly elevated serum Ca19-9 at diagnosis, and BMI ≥ 25 kg/m2 may be at higher risk for positive peritoneal cytology, regardless of whether neoadjuvant therapy is administered.
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Availability of data and materials
A limited dataset devoid of patient identifiers was created from a maintained database of pancreatic adenocarcinoma patients at Fox Chase Cancer Center and stored on a server maintained by the FCCC Information Systems and Technology Department. The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.
Code availability
Statistical analyses were performed on the deidentified dataset using Stata 15.1 statistical software (StataCorp, College Station, TX, United States).
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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board (IRB) of Fox Chase Cancer Center approved this study, Institutional IRB Approval 14-837.
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A Waiver of Informed Consent and HIPAA Authorization was granted because (a) this research is a retrospective chart review project and the research involves no more than minimal risk to the subjects including loss of confidentiality, and (b) the study could not practicably be conducted without access to and use of subjects’ protected health information that consists of those data elements used to create a limited data set, and (c) the study could not practicably be carried out without these waivers, and the waivers will not adversely affect the rights and welfare of the subjects. IRB 14-837 grants permission for the results of the study to be presented at local and national meetings and to be published in a reputable scientific journal.
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O’Halloran, E.A., Board, T., Lefton, M. et al. Predicting positive peritoneal cytology in pancreatic cancer. J Cancer Res Clin Oncol 147, 1825–1832 (2021). https://doi.org/10.1007/s00432-020-03471-9
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DOI: https://doi.org/10.1007/s00432-020-03471-9