Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Hoyler, M.
Impact of invasion type of ductal adenocarcinoma of the pancreas on local recurrence and distant metastasis
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp. 68
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Lackner Karoline
- Marsoner Katharina
- Altmetrics:
- Abstract:
- Background Pancreatic ductal adenocarcinoma (PDAC) is characterised by unfavourable long-term survival. Perineural, lymphovascular, and microvascular invasion (PNI, LVI and MVI) as well as the number of lymph node metastases and resection margin status are known risk factors. However, the impact of the exact number of such invasion events on disease-free and overall survival is not known. In this study we therefore aimed to assess the role of the number of perineural, lymphovascular and microvascular invasions, and the distance of the carcinoma to the resection margins and compare the prognostic utility of these and other histological and clinical factors for the prediction of disease-free and overall survival. Methods A retrospective detailed histopathological evaluation of 88 PDAC cases with completely sampled pancreatic head after classical or pylorus-preserving Whipple procedure was conducted. Each case was evaluated for the exact number of perineural, lymphovascular and microvascular invasions, the number of lymph node metastases and the distance of the carcinoma from the resection margins was measured. In addition, demographic data, comorbidities, patient management characteristics and histopathological features were analysed for their impact on disease-free survival and overall survival. Results Kaplan-Meier analysis showed that cases with = 30 perineural invasions, as well as lymphovascular and microvascular invasion were associated with shorter disease-free and overall survival as compared to patients without these morphological features, whereas no differences were found with respect to a distance from the circumferential resection margin of more or less than 1mm. For disease-free survival univariate Cox regression identified tumour differentiation grade, >30 PNI, LVI, MVI, presence of lymph node metastasis, ratio of total to cancer-infested lymph nodes (LNR) as histological and preoperative symptoms and intraoperative treatment with inotropics as clinical parameters associated with shorter DFS. Multivariate Cox regression revealed grade, LNR and preoperative symptoms (weight loss, pancreatitis) as independent predictors of DFS. For overall survival the same histological and similar clinical parameters as for DFS and Charlson Comorbidity Index were found to be associated with OAS on univariate Cox regression. However, only MVI and LNR were identified as histological and preoperative symptoms as clinical independent predictors of outcome. Conclusion DFS and OAS is best predicted by a combination of histological and clinical factors. Complete sampling of the pancreatic head in cases with PDAC enables efficient detection of morphological features of invasion of which tumour differentiation grade, PNI>30 and MVI emerged as potent predictors of outcome.