Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Pancreatology. 2020 Jan;20(1):110-115. doi: 10.1016/j.pan.2019.11.003. Epub 2019 Nov 14.
Pre-operative staging of pancreatic adenocarcinoma guides clinical decision making. Limited data indicate that metastasis to celiac ganglia (CG) correlates with poor prognosis. We investigated feasibility and safety of endoscopic ultrasound fine needle aspiration (EUS-FNA) detection of CG metastasis and its impact upon tumor stage, resectability, and survival in pancreatic ductal adenocarcinoma (PDAC).
We reviewed our prospectively maintained EUS and cytopathology databases to identify patients with FNA proven CG metastasis in patients with PDAC from 2004 to 2017. Clinical demographics, EUS, CT, MRI, cytopathology, cancer stage, and resectability data were analyzed. Survival of PDAC patients with CG metastasis was compared to the expected survival of PDAC patients of similar stage as reported by the United States National Cancer Database.
Twenty-one patients with PDAC [median age 73 (IQR63-78); 14 (67%) female)], had CG metastasis confirmed by cytopathologic assessment. CG metastasis resulted in tumor upstaging relative to other EUS findings and cross sectional imaging findings in 12 (57%) and 15 (71%) patients, and converted cancers from resectable to unresectable relative to EUS and cross sectional imaging in 7 (37%) and 7 (37%) patients, respectively. In patients with PDAC, the survival of patients with CG metastasis was not significantly different from the overall survival (hazard ratio 0.71; 95% confidence interval 0.44, 1.13; p = 0.15).
EUS-FNA may safely identify CG metastases. While CG metastasis upstaged and altered the resectability status among this cohort of patients with PDAC, the survival data with regard to PDAC suggest that this may be misguided.
胰腺癌的术前分期指导临床决策。有限的数据表明，腹腔神经节（CG）转移与预后不良相关。我们研究了内镜超声细针抽吸（EUS-FNA）检测胰腺导管腺癌（PDAC）中 CG 转移的可行性和安全性，及其对肿瘤分期、可切除性和生存的影响。
我们回顾了我们前瞻性维护的 EUS 和细胞病理学数据库，以确定 2004 年至 2017 年间经 FNA 证实的 PDAC 患者中 CG 转移的患者。分析了临床人口统计学、EUS、CT、MRI、细胞病理学、癌症分期和可切除性数据。CG 转移的 PDAC 患者的生存与美国国家癌症数据库报告的类似分期 PDAC 患者的预期生存进行了比较。
21 例 PDAC 患者[中位年龄 73（IQR63-78）；14（67%）女性]，通过细胞病理学评估证实存在 CG 转移。CG 转移导致 12 例（57%）和 15 例（71%）患者的肿瘤分期高于其他 EUS 发现和横断面成像发现，使 7 例（37%）和 7 例（37%）患者的癌症从可切除变为不可切除，相对于 EUS 和横断面成像。在 PDAC 患者中，CG 转移患者的生存与总生存无显著差异（风险比 0.71；95%置信区间 0.44，1.13；p=0.15）。
EUS-FNA 可安全地识别 CG 转移。虽然 CG 转移使该队列中的 PDAC 患者分期升高并改变了可切除性状态，但 PDAC 的生存数据表明，这可能是误导性的。
