Taherian Mehran, Katz Matthew H G, Prakash Laura R, Wei Dongguang, Tong Yi Tat, Lai Zongshan, Chatterjee Deyali, Wang Hua, Kim Michael, Tzeng Ching-Wei D, Ikoma Naruhiko, Wolff Robert A, Zhao Dan, Koay Eugene J, Maitra Anirban, Wang Huamin
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2024 Sep 27;16(19):3312. doi: 10.3390/cancers16193312.
Adequate sampling is essential to an accurate pathologic evaluation of pancreatectomy specimens resected for pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy (NAT). However, limited data are available for the association between the sampling and survival in these patients. We examined the association of the entire submission of the tumor (ESOT) and the entire submission of the pancreas (ESOP) with disease-free survival (DFS) and overall survival (OS), as well as their correlations with clinicopathologic features, for 627 patients with PDAC who received NAT and pancreaticoduodenectomy. We demonstrated that both ESOT and ESOP were associated with lower ypT, less frequent perineural invasion, and better tumor response ( < 0.05). ESOP was also associated with a smaller tumor size ( < 0.001), more lymph nodes ( < 0.001), a lower ypN stage ( < 0.001), better differentiation ( = 0.02), and less frequent lymphovascular invasion ( = 0.009). However, since ESOP and ESOT were primarily conducted for cases with no grossly identifiable tumor or minimal residual carcinoma in initial sections, potential bias cannot be excluded. Both ESOT and ESOP were associated with less frequent recurrence/metastasis and better DFS and OS ( < 0.05) in the overall study population. ESOP was associated with better DFS and better OS in patients with ypT0/ypT1 or ypN0 tumors and better OS in patients with complete or near-complete response ( < 0.05). ESOT was associated with better OS in patients with ypT0/ypT1 or ypN0 tumors ( < 0.05). Both ESOT and ESOP were independent prognostic factors for OS according to multivariate survival analyses. Therefore, accurate pathologic evaluation using ESOP and ESOT is associated with the prognosis in PDAC patients with complete or near-complete pathologic response and ypT0/ypT1 tumor after NAT.
充分采样对于新辅助治疗（NAT）后因胰腺导管腺癌（PDAC）而切除的胰腺切除术标本进行准确的病理评估至关重要。然而，关于这些患者采样与生存之间关联的数据有限。我们研究了627例接受NAT和胰十二指肠切除术的PDAC患者的肿瘤完整送检（ESOT）和胰腺完整送检（ESOP）与无病生存期（DFS）和总生存期（OS）的关联，以及它们与临床病理特征的相关性。我们证明ESOT和ESOP均与较低的ypT、较少见的神经周围侵犯以及较好的肿瘤反应相关（P<0.05）。ESOP还与较小的肿瘤大小相关（P<0.001）、更多的淋巴结（P<0.001）、较低的ypN分期（P<0.001）、较好的分化程度（P=0.02）以及较少见的淋巴管侵犯相关（P=0.009）。然而，由于ESOP和ESOT主要针对初始切片中无明显肉眼可见肿瘤或残留癌极少的病例进行，无法排除潜在偏倚。在整个研究人群中，ESOT和ESOP均与较少见的复发/转移以及较好的DFS和OS相关（P<0.05）。ESOP与ypT0/ypT1或ypN0肿瘤患者的较好DFS和较好OS相关，与完全或接近完全缓解的患者的较好OS相关（P<0.05）。ESOT与ypT0/ypT1或ypN0肿瘤患者的较好OS相关（P<0.05）。根据多因素生存分析，ESOT和ESOP均为OS的独立预后因素。因此，使用ESOP和ESOT进行准确的病理评估与NAT后具有完全或接近完全病理反应以及ypT0/ypT1肿瘤的PDAC患者的预后相关。
