TY - JOUR
T1 - Does size matter in pancreatic cancer?
T2 - Reappraisal of tumour dimension as a predictor of outcome beyond the TNM
AU - Marchegiani, Giovanni
AU - Andrianello, Stefano
AU - Malleo, Giuseppe
AU - De Gregorio, Lucia
AU - Scarpa, Aldo
AU - Mino-Kenudson, Mari
AU - Maggino, Laura
AU - Ferrone, Cristina R.
AU - Lillemoe, Keith D.
AU - Bassi, Claudio
AU - Castillo, Carlos Fernàndez Del
AU - Salvia, Roberto
N1 - Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017
Y1 - 2017
N2 - Objective: To explore the role of pancreatic ductal adenocarcinoma (PDAC) size on surgical and survival outcomes. Background: Tumor size is a prognostic factor for the majority of solid cancers, but the role for PDAC in predicting survival is not well delineated affecting the reliability of tumor node metastasis system classification. Methods: Between 1998 and 2012, 1507 patients with PDAC underwent resection at University of Verona Hospital and the Massachusetts General Hospital. All data were collected prospectively. Tumor size has been measured both at imaging and gross pathology. Results: Among the tumors measured, 21.5% were <20mm and 78.5% >20 mm. Larger tumors were associated with higher Ca19.9, T3-T4 and N1, higher grade, perineural invasion, R1 resections, more positive lymph nodes, and higher lymph node ratios (P < 0.05). Tumours <20mm showed a better prognosis (33 vs 23 months; P < 0.01), but worse surgical results with higher pancreatic fistula (21.1% vs 14.6%; P < 0.01) and mortality rates (1.5% vs 0.3%; P = 0.04). PDAC size was associated with worse prognosis (hazard ratio 1.26, P = 0.02), together with Ca19.9, grading, and N1. When measured at imaging, tumor size was underestimated (median 23 vs 30mm; P < 0.01) and did not influence prognosis Conclusions: PDAC size >20 mm, measured at gross pathology, correlates with surgical outcomes and is an independent predictor of poor prognosis. Given that imaging underestimates size by about 20%, perhaps tumors that measure >20mm at imaging should be considered for neoadjuvant treatment regardless of resectability.
AB - Objective: To explore the role of pancreatic ductal adenocarcinoma (PDAC) size on surgical and survival outcomes. Background: Tumor size is a prognostic factor for the majority of solid cancers, but the role for PDAC in predicting survival is not well delineated affecting the reliability of tumor node metastasis system classification. Methods: Between 1998 and 2012, 1507 patients with PDAC underwent resection at University of Verona Hospital and the Massachusetts General Hospital. All data were collected prospectively. Tumor size has been measured both at imaging and gross pathology. Results: Among the tumors measured, 21.5% were <20mm and 78.5% >20 mm. Larger tumors were associated with higher Ca19.9, T3-T4 and N1, higher grade, perineural invasion, R1 resections, more positive lymph nodes, and higher lymph node ratios (P < 0.05). Tumours <20mm showed a better prognosis (33 vs 23 months; P < 0.01), but worse surgical results with higher pancreatic fistula (21.1% vs 14.6%; P < 0.01) and mortality rates (1.5% vs 0.3%; P = 0.04). PDAC size was associated with worse prognosis (hazard ratio 1.26, P = 0.02), together with Ca19.9, grading, and N1. When measured at imaging, tumor size was underestimated (median 23 vs 30mm; P < 0.01) and did not influence prognosis Conclusions: PDAC size >20 mm, measured at gross pathology, correlates with surgical outcomes and is an independent predictor of poor prognosis. Given that imaging underestimates size by about 20%, perhaps tumors that measure >20mm at imaging should be considered for neoadjuvant treatment regardless of resectability.
KW - Dimension
KW - Neoadjuvant therapy
KW - PDAC
KW - Pancreatic cancer
KW - Pancreatic ductal adenocarcinoma
KW - Pancreaticoduodenectomy
KW - Size
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U2 - 10.1097/SLA.0000000000001837
DO - 10.1097/SLA.0000000000001837
M3 - Article
C2 - 27322188
AN - SCOPUS:84975522464
VL - 266
SP - 142
EP - 148
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 1
ER -