Watanabe Kazuo, Mitsunaga Shuichi, Kojima Motohiro, Suzuki Hidetaka, Irisawa Ai, Takahashi Hideaki, Sasaki Mitsuhito, Hashimoto Yusuke, Imaoka Hiroshi, Ohno Izumi, Ikeda Masafumi, Akimoto Tetsuo, Ochiai Atsushi
Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Cancer Med. 2020 May;9(9):3130-3141. doi: 10.1002/cam4.2954. Epub 2020 Mar 5.
In the case of liver metastasis (LM), tumors showing the replacement growth pattern (RGP), in which metastatic cells infiltrate and replace hepatocytes with minimal desmoplastic reaction and inflammatory cell infiltration, associate with a poor prognosis. The heterogeneity, frequency, and prognostic value of the RGP in LM from pancreatic cancer (PCa) are not well known.
In the circumference of treatment-naïve resected LMs from patients with PCa, the heterogeneity of the GP was assessed. Next, the clinicopathological features of LMs showing the RGP in needle biopsy specimens were investigated in patients with treatment-naïve advanced PCa.
Thirteen of the 14 (93%) in all resected LMs and 7 of the 9 (78%) in RGP component GP in resected LMs showed homogeneous GP. A RGP was found in 50% of the needle biopsy specimens of LMs obtained from 107 patients. The median overall survival times in the RGP group and non-RGP group were 3.6 and 10.4 months. Multivariate analysis identified RGP as an independent poor prognostic factor. Median value of CD8 positive percentage in RGP was lower than that in non-RGP (0.75 vs 1.46, P = .04). Median overall survival times in low CD8 groups tend to be shorter than those in high CD8 group (8.2 vs 4.2 months).
Most LMs from PCa show a homogeneous GP. The RGP was observed in about a half of the LMs from PCa patients, and was identified as a poor prognostic factor.
在肝转移（LM）的情况下，肿瘤呈现替代生长模式（RGP），即转移细胞浸润并取代肝细胞，同时伴有最小程度的促纤维增生反应和炎症细胞浸润，这种情况与预后不良相关。胰腺癌（PCa）肝转移中RGP的异质性、频率及预后价值尚不清楚。
在未经治疗的PCa患者切除的肝转移灶周边，评估生长模式（GP）的异质性。接下来，在未经治疗的晚期PCa患者中，研究针吸活检标本中显示RGP的肝转移灶的临床病理特征。
所有切除的肝转移灶中，14个中有13个（93%），切除的肝转移灶中RGP成分的GP里9个中有7个（78%）显示为均匀的GP。在107例患者获取的肝转移灶针吸活检标本中，50%发现有RGP。RGP组和非RGP组的中位总生存时间分别为3.6个月和10.4个月。多因素分析确定RGP是一个独立的不良预后因素。RGP中CD8阳性百分比的中位数低于非RGP组（0.75对1.46，P = 0.04）。低CD8组的中位总生存时间往往比高CD8组短（8.2对4.2个月）。
大多数PCa肝转移灶显示为均匀的GP。在约一半的PCa患者肝转移灶中观察到RGP，并被确定为不良预后因素。
