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Does Site Matter? Impact of Tumor Location on Pathologic Characteristics, Recurrence, and Survival of Resected Pancreatic Ductal Adenocarcinoma

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

Abstract

Background

The authors hypothesized that in resected pancreatic adenocarcinoma (PDAC), pathologic characteristics, oncologic outcomes, prognostic factors, and the accuracy of the American Joint Committee on Cancer (AJCC) staging system might differ based on tumor location.

Methods

Patients undergoing pancreatectomy for PDAC at two academic institutions from 2000 to 2015 were retrieved. A comparative analysis between head (H-PDAC) and body–tail (BT-PDAC) tumors was performed using uni- and multivariable models. The accuracy of the eighth AJCC staging system was analyzed using C-statistics.

Results

Among 1466 patients, 264 (18%) had BT-PDAC, which displayed greater tumor size but significantly lower rates of perineural invasion and G3/4 grading. Furthermore, BT-PDAC was associated with a lower frequency of nodal involvement and a greater representation of earlier stages. The recurrence-free survival and disease-specific survival times were longer for BT-PDAC (16 vs 14 months [p = 0.020] and 33 vs 26 months [p = 0.026], respectively), but tumor location was not an independent predictor of recurrence or survival in the multivariable analyses. The recurrence patterns did not differ. Certain prognostic factors (i.e., CA 19.9, grading, R-status, and adjuvant treatment) were common, whereas others were site-specific (i.e., preoperative pain, diabetes, and multivisceral resection). The performances of the AJCC staging system were similar (C-statistics of 0.573 for H-PDAC and 0.597 for BT-PDAC, respectively).

Conclusions

Despite differences in pathologic profile found to be in favor of BT-PDAC, tumor location was not an independent predictor of recurrence or survival after pancreatectomy. An array of site-specific prognostic factors was identified, but the AJCC staging system displayed similar prognostic power regardless of primary tumor location.

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Acknowledgements

This study was funded by the Associazione Italiana per la Ricerca sul Cancro (AIRC 5x1000 n. 12182).

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Authors and Affiliations

  1. Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy

    Giuseppe Malleo MD, PhD, Laura Maggino MD, Giovanni Marchegiani MD, PhD, Salvatore Paiella MD, PhD, Claudio Bassi MD, FACS & Roberto Salvia MD, PhD

  2. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Cristina R. Ferrone MD, FACS, Motaz Qadan MD, PhD, FACS, Keith D. Lillemoe MD, FACS & Carlos Fernàndez-del Castillo MD, FACS

  3. Department of Pathology and Diagnostics, University of Verona Hospital Trust, Verona, Italy

    Claudio Luchini MD & Aldo Scarpa MD

  4. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Mari Mino-Kenudson MD

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  1. Giuseppe Malleo MD, PhD
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  2. Laura Maggino MD
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  3. Cristina R. Ferrone MD, FACS
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  4. Giovanni Marchegiani MD, PhD
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  8. Motaz Qadan MD, PhD, FACS
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  10. Keith D. Lillemoe MD, FACS
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  13. Roberto Salvia MD, PhD
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Correspondence to Roberto Salvia MD, PhD.

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Disclosure

Dr. Motaz Qadan was paid consulting fee by Olympus. The remaining authors had no conflicts of interest.

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Malleo, G., Maggino, L., Ferrone, C.R. et al. Does Site Matter? Impact of Tumor Location on Pathologic Characteristics, Recurrence, and Survival of Resected Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 27, 3898–3912 (2020). https://doi.org/10.1245/s10434-020-08354-4

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  • DOI: https://doi.org/10.1245/s10434-020-08354-4

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