Is tumor necrosis a clinical prognostic factor in hepato‐biliary‐pancreatic cancers? A systematic review and meta‐analysis

Abstract

Background It has been proven that tumor necrosis is associated with poor prognoses in various solid malignant tumors. However, the prognostic effect of tumor necrosis in hepato‐biliary‐pancreatic cancers is still unclear. Therefore, this study was performed to evaluate the associations of tumor necrosis with survival outcomes and clinicopathological features in patients with hepato‐biliary‐pancreatic cancers. Methods Based on the PRISMA statement, eligible studies were identified from PubMed, Embase, Cochrane Library, and Web of Science from inception until January 2023. The pooled hazard ratios (HRs) and 95% confidence intervals (95%CIs) were calculated to assess the connection between tumor necrosis and hepato‐biliary‐pancreatic cancers. We then choose which effects model to use to generate pooled HRs and 95% CIs, depending on data heterogeneity. Results In total, 6497 articles were identified, 10 of which were included in this meta‐analysis. Our results suggested that the presence of tumor necrosis predicted a poorer outcome for overall survival (HR = 1.54, 95% CI = 1.35–1.77, p < 0.001) and recurrence‐free survival (HR = 1.69, 95% CI = 1.37–2.08, p < 0.001). In addition, tumor necrosis was correlated with larger tumor size, a higher frequency of lymph node metastasis, poorer histologic differentiation, and higher recurrence and metastasis rates. Conclusion Our meta‐analysis suggests that hepato‐biliary‐pancreatic cancer patients with tumor necrosis have dismal survival outcomes, and that their tumors have aggressive biological behaviors. Tumor necrosis has the potential to be a promising biomarker for forecasting poor prognosis in these patients.

CT Attenuation of Hepatic Pancreatic Cancer Metastases Correlates with Prognostically Detrimental Metastatic Necrosis

“…In a systematic review, the presence of tumor necrosis of solid tumors was reported for several entities, including breast, renal cell, non-small cell lung, and colorectal cancer, as a negative prognostic histopathological feature [4]. In the case of PDAC, a recent metaanalysis identified the detrimental prognostic role of tumor necrosis of the primary tumor in histopathology on overall survival (OS), recurrence-free survival, vascular and neural invasion, T stage, M stage, and grading [5][6][7][8]. Another recent study described a significant correlation of MRI-depicted tumor necrosis of PDAC to tumor size, nodal status, and metastases [9], while another study reported higher tumor grading and higher cellularity co-occurring with tumor necrosis determined by MRI [10].…”