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

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgment

This work was supported by NIH Grants (CA62924 and R01CA176828), the Rolfe Pancreatic Cancer Foundation, and Susan Wojcicki and Dennis Troper.

Disclosures

The authors do not have any relevant disclosures.

Author information

Authors and Affiliations

  1. Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Marco Dal Molin MD, Abdulrehman Siddiqui MB, Aaron Brant BS, Christy Cho BS, Jun Yu MD, PhD, Ralph H. Hruban MD & Michael Goggins MD

  2. Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Amanda L. Blackford MSc, Ralph H. Hruban MD & Michael Goggins MD

  3. Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Neda Rezaee MB, Jin He MD, PhD, Matthew Weiss MD & Christopher Wolfgang MD, PhD

  4. Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Goggins MD

  5. Department of Pathology, Johns Hopkins Medical Institutions, 1550 Orleans Street, Baltimore, MD, 21231, USA

    Michael Goggins MD

Authors
  1. Marco Dal Molin MD
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  2. Amanda L. Blackford MSc
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  3. Abdulrehman Siddiqui MB
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  4. Aaron Brant BS
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  5. Christy Cho BS
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  6. Neda Rezaee MB
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  7. Jun Yu MD, PhD
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  8. Jin He MD, PhD
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  9. Matthew Weiss MD
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  10. Ralph H. Hruban MD
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  11. Christopher Wolfgang MD, PhD
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  12. Michael Goggins MD
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Corresponding author

Correspondence to Michael Goggins MD.

Electronic supplementary material

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Supplementary Figure Legend

Survival among patients with pancreatic ductal adenocarcinomas involving the head of the pancreas stratified by type of involvement for each tumor size category (<2, 2-4, >4cm). A: 5-year survival, B: Overall survival. Supplementary material 1 (PDF 88 kb)

Supplementary material 2 (DOCX 50 kb)

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Dal Molin, M., Blackford, A.L., Siddiqui, A. et al. Duodenal Involvement is an Independent Prognostic Factor for Patients with Surgically Resected Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 24, 2379–2386 (2017). https://doi.org/10.1245/s10434-017-5864-9

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  • DOI: https://doi.org/10.1245/s10434-017-5864-9

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