Prognostic implication of extra-pancreatic organ invasion in resectable pancreas ductal adenocarcinoma in the pancreas tail

• Published in: European journal of radiology Vol. 181; p. 111715
• Main Authors: Ji Jang, Hyeon, Soo Lee, Seung, Baek, Seunghee, Jeong, Boryeong, Wook Kim, Dong, Hee Kim, Jin, Jung Kim, Hyoung, Ho Byun, Jae, Lee, Woohyung, Cheol Kim, Song
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-12-2024
• Subjects: Extra-pancreatic organ invasion; Pancreas tail; Pancreatic ductal adenocarcinoma; Prognosis; Surgery; LN; Prognosis; RAMPS; OS; Pancreatic ductal adenocarcinoma; Extra-pancreatic organ invasion; CT; PDAC; Pancreas tail; Surgery; CA 19–9; RFS; BMI
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2024.111715

•PDAC in the pancreas tail often invades into nearby extra-pancreatic organs, however, its prognostic significance remains unclear.•Extra-pancreatic organ invasion dose not influence pathologic resection margin status and risk of recurrence or death in resectable PDAC.•Technically resectable extra-pancreatic organ invasion should not be considered as a high-risk factor for resectable PDAC in the pancreas tail.
To assess the prognostic significance of extra-pancreatic organ invasion in patients with resectable pancreatic ductal adenocarcinoma (PDAC) in the pancreas tail.
This retrospective study included patients with resectable PDAC in the pancreas tail who received upfront surgery between 2014 and 2020 at a tertiary institution. Preoperative pancreas protocol computed tomography (CT) scans evaluated tumor size, peripancreatic tumor infiltration, suspicious metastatic lymph nodes, and extra-pancreatic organ invasion. The influence of extra-pancreatic organ invasion, detected by CT or postoperative pathology, on pathologic resection margin status was evaluated using logistic regression. The impact on recurrence-free survival (RFS) was analyzed using multivariable Cox proportional hazard models (clinical-CT and clinical-pathologic).
The study included 158 patients (mean age, 65 years ± 8.8 standard deviation; 93 men). Extra-pancreatic organ invasion identified by either CT (p = 0.92) or pathology (p = 0.99) was not associated with a positive resection margin. Neither CT (p = 0.42) nor pathological (p = 0.64) extra-pancreatic organ invasion independently correlated with RFS. Independent predictors for RFS included suspicious metastatic lymph node (hazard ratio [HR], 2.05; 95 % confidence interval [CI], 1.08–3.9; p = 0.03) on CT in the clinical-CT model, pathological T stage (HR, 2.97; 95 % confidence interval [CI], 1.39–6.35; p = 0.005 for T2 and HR, 3.78; 95 % CI, 1.64–8.76; p = 0.002 for T3) and adjuvant therapy (HR, 0.62; 95 % confidence interval [CI], 0.42–0.92; p = 0.02) in the clinical-pathologic model.
Extra-pancreatic organ invasion does not independently influence pathologic resection margin status and RFS in patients with resectable PDAC in the pancreas tail after curative-intent resection; therefore, it should not be considered a high-risk factor.