Detailed Abstract
[Oral Presentation 6 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[OP 6-7] Venous invasion as an upstaging factor in pancreatic head cancer compared to pancreatic tail cancer?
Min Kyu SUNG1 , Woohyung LEE*1 , Yoo Na LEE1 , Young Hoon ROH1 , Young Jae KWON1 , Yun Beom RYU1 , Dakyum SHIN1 , Sarang HONG1 , Yejong PARK1 , Bong Jun KWAK1 , Ki Byung SONG1 , Jae Hoon LEE1 , Dae Wook HWANG1 , Song Cheol KIM1
1 Division Of Hepatobiliary And Pancreatic Surgery, Department Of Surgery, Asan Medical Center, University Of Ulsan College Of Medicine, REPUBLIC OF KOREA
Background : It has been reported that there was a difference in the oncological characteristics of pancreatic head cancer (PHC) and pancreatic body/tail cancer (PBTC) according to the tumor location. In our previous study, we reported that the prognosis between the two groups may differ depending on the size of pancreatic cancer. Because pancreatic cancer is classified according to the same staging system regardless of tumor location, we studied whether the same staging system can be applied according to the tumor location.
Methods : We retrospectively reviewed patients who underwent curative-intent surgery for pathologically proven pancreatic ductal adenocarcinoma (PDAC) between 2000 and 2019 in a tertiary referral center. The log-rank test was performed to compare the median overall survival (OS) and disease-free survival (DFS) rates between PHC and PBTC and subgroup analysis was performed in each TNM staging system.
Results : Of 2,713 patients, PHC and PBTC were found in 1,878 and 835 patients retrospectively. Patients with PHC had worse median OS rates in stage T1 (35 months vs 56 months, p=0.017) and T2 (23 months vs 31 months, p=0.001) category, N1 category (20 months vs 25 months, p=0.040), and stage IIB (20 months vs 25 months, p=0.032) than those with PBTC as well as worse median RFS rates in PBTC. Otherwise, there were no significant differences in other stages. In the subgroup analysis of stage IIB, PHC patients with venous invasion showed worse median OS rate (23 months vs 18 months, p = 0.003) and RFS rate (10 months vs 9 months, p=0.009) than PHC patients without venous invasion in the T2N1 stage and there was no significant difference of the median OS rate between PHC without venous invasion and patients with PBTC in the T2N1 stage (23 months vs 27 months, p =0.112). In addition, PHC patients with venous invasion in the T2N1 stage showed comparable median OS (18 months vs 16 months, p = 0.177) and RFS (9 months vs 7 months, p = 0.061) rates compared with stage III patients. We reclassified patients in the T2N1 stage with venous invasion in PHC from stage IIB to stage III. In multivariate analysis, the reclassified staging system was identified as an independent prognostic factor.
Conclusions : In the T2N1 stage, PHC patients with venous invasion were revealed as an upstaging factor. Otherwise, the overall prognostic performance of the current staging system in PDAC was comparable between PHC and PBTC. This finding needs to be confirmed in external validation studies.
Methods : We retrospectively reviewed patients who underwent curative-intent surgery for pathologically proven pancreatic ductal adenocarcinoma (PDAC) between 2000 and 2019 in a tertiary referral center. The log-rank test was performed to compare the median overall survival (OS) and disease-free survival (DFS) rates between PHC and PBTC and subgroup analysis was performed in each TNM staging system.
Results : Of 2,713 patients, PHC and PBTC were found in 1,878 and 835 patients retrospectively. Patients with PHC had worse median OS rates in stage T1 (35 months vs 56 months, p=0.017) and T2 (23 months vs 31 months, p=0.001) category, N1 category (20 months vs 25 months, p=0.040), and stage IIB (20 months vs 25 months, p=0.032) than those with PBTC as well as worse median RFS rates in PBTC. Otherwise, there were no significant differences in other stages. In the subgroup analysis of stage IIB, PHC patients with venous invasion showed worse median OS rate (23 months vs 18 months, p = 0.003) and RFS rate (10 months vs 9 months, p=0.009) than PHC patients without venous invasion in the T2N1 stage and there was no significant difference of the median OS rate between PHC without venous invasion and patients with PBTC in the T2N1 stage (23 months vs 27 months, p =0.112). In addition, PHC patients with venous invasion in the T2N1 stage showed comparable median OS (18 months vs 16 months, p = 0.177) and RFS (9 months vs 7 months, p = 0.061) rates compared with stage III patients. We reclassified patients in the T2N1 stage with venous invasion in PHC from stage IIB to stage III. In multivariate analysis, the reclassified staging system was identified as an independent prognostic factor.
Conclusions : In the T2N1 stage, PHC patients with venous invasion were revealed as an upstaging factor. Otherwise, the overall prognostic performance of the current staging system in PDAC was comparable between PHC and PBTC. This finding needs to be confirmed in external validation studies.
SESSION
Oral Presentation 6
Room A 3/5/2022 10:10 AM - 11:00 AM