Long-Term Survival After Curative Resection for Pancreatic Ductal Adenocarcinoma

Conlon, Kevin C.; Klimstra, David S.; Brennan, Murray F.

doi:10.1097/00000658-199603000-00007

Cited by 669 publications

(383 citation statements)

References 29 publications

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“…2,3 Both the evolution of more sophisticated imaging and better accessibility through improvements in surgical procedures have allowed more recognition of pancreatic lesions at earlier stages of detection. The current classification schemes divide pancreatic neoplasms into solid or cystic lesions and epithelial cell type: ductal, acinar, and endocrine.…”

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confidence: 99%

Clear cell carcinoma of the pancreas: histopathologic features and a unique biomarker: hepatocyte nuclear factor-1β

et al. 2008

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Clear cell carcinoma as a variant of ductal carcinoma of the pancreas is not well recognized. Hepatocyte nuclear factor-1b as a transcription factor has been identified as a specific biomarker of clear cell tumor of the female genital tract. The aim of this study was to systematically analyze clear cell carcinoma of the pancreas and its unique biomarker hepatocyte nuclear factor-1b. A total of 84 pancreatic adenocarcinomas were analyzed pathologically and with an immunohistochemical approach with hepatocyte nuclear factor-1b antibody. The identified clear cell carcinomas were further studied by PAS, DPAS, and mucicarmine stains. Pathologic features and clinical follow-up were documented. Of them, 20 (24%) pancreatic adenocarcinomas were identified with clear cell features, including 12 clear cell carcinomas and 8 ductal adenocarcinomas with clear cell component (defined as less than 75% of tumor with clear cells). Cytologically, the clear cell carcinomas exhibited clear cytoplasm with centrally located, atypical nuclei. PAS, DPAS, and mucicarmine stains confirmed that the clear cytoplasm was not due to accumulation of glycogen or mucin. The results of immunostaining showed that hepatocyte nuclear factor-1b is overexpressed in all clear cell carcinomas and in the clear cell components of eight ductal carcinomas with clear cell features. In contrast, in usual ductal adenocarcinoma, hepatocyte nuclear factor-1b exhibited overall weak or focally moderate staining; only eight cases were strongly positive (15%) of which 38% were high grade and 63% were moderate grade. However, when included with the strong staining cases in mixed and clear cell carcinoma, this group regardless of morphology appeared to correlate with worse survival compared to the group with weak hepatocyte nuclear factor-1b staining across morphologies (Po0.01). Thus, clear cell carcinoma of the pancreas is not an uncommon variant of pancreatic ductal adenocarcinoma. Hepatocyte nuclear factor-1b is a useful marker to identify these clear cell carcinomas, and its overexpression may aid in stratifying survival rate.

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confidence: 99%

Clear cell carcinoma of the pancreas: histopathologic features and a unique biomarker: hepatocyte nuclear factor-1β

et al. 2008

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“…Tumour resection is performed in only 9 -36% of all patients. Even in those patients fortunate enough to have a resectable lesion, the 5-year survival rate following resection is 11 -24% (Conlon et al, 1996;Yamamoto et al, 1998;Sener et al, 1999). The reasons behind the aggressiveness of pancreatic carcinoma are not clearly understood.…”

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confidence: 99%

Impact of caveolin-1 expression on prognosis of pancreatic ductal adenocarcinoma

et al. 2002

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Caveolin-1 is a major component of caveolae and plays a regulatory role in several signalling pathways. Caveolin-1 was recently identified as a metastasis-related gene in prostate cancer. The clinical effects of caveolin-1 expression in pancreatic carcinoma, however, remain unknown. In this study, we have investigated the relationship between caveolin-1 expression and the clinicopathologic variables and clinical outcome in 79 patients with pancreatic adenocarcinoma undergoing surgical resection. Caveolin-1 expression was determined by immunohistochemistry, using a polyclonal anti-caveolin-1 antibody. Patients were divided into two groups based on the extent of caveolin-1 expression: a negative expression group (immunoreactivity in less than 50% of cells) and a positive expression group. Positive caveolin-1 immunostaining was detected in 32 cases (40.5% of total), while non-neoplastic ductal epithelium showed little or no staining. Positive caveolin-1 expression was correlated with tumour diameter (P=0.0079), histopathologic grade (P=0.0272) and poor prognosis (P=0.0008). Upon multivariate analysis with Cox's proportional hazards model, positive caveolin-1 expression was shown to be an independent negative predictor for survival (P=0.0358). These results suggest that caveolin-1 overexpression is associated with tumour progression, thereby indicating a poor prognosis for certain patients undergoing surgical resection for pancreatic carcinoma.

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“…These patterns have also been confirmed in multiple studies [16,17]. Thus it may be naïve to assume that 5-year survival is synonymous with cure.…”

Section: Introductionmentioning

confidence: 59%

“…Spread to the lymph nodes is associated with a median survival of <17 months compared with 5-year survival rates of up to 38 % in patients without lymph node involvement [58]. Not only lymph node positivity but also the number and the ratio of metastatic/examined nodes has been found to have bearing on the outcome of pancreatic cancer patients [16,60]. As has been seen in colon and gastric cancer, the number of negative nodes examined also impacts prognosis [61,62].…”

Section: Extended Lymphadenectomymentioning

confidence: 97%

Improving Survival of Pancreatic Cancer. What Have We Learnt?

Singh

Chaudhary

2015

Indian J Surg

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Pancreatic adenocarcinoma still ranks high among cancer-related deaths worldwide. In spite of substantial strides in preoperative staging, surgery, perioperative care, and adjuvant treatment, the survival still remains dismal. A number of patient-, disease-, and surgeon-related factors play a role in deciding the eventual outcome of the patient. The aim of this commentary is to review the current knowledge of various factors and the recent advances that impact the survival of patients with pancreatic adenocarcinoma. A search of scientific literature using Embase and MEDLINE, for the years 1985-2015, was carried out for search terms Bpancreatic cancer^and Bsurvival.^Further search was based on the various specific prognostic factors that contribute towards survival of patients with pancreatic cancer found in the literature. Most of the studies used for this review include those that deal with pancreatic head cancers, some include patients with pancreatic cancers in all locations while very few included patients with tumors of body and tail only. In spite of significant developments in pre-and perioperative management, increased rates of margin-negative resections, and use of adjuvant treatment, the survival rates of pancreatic cancer patients remains poor. A paradigm shift with more effective adjuvant regimen and genetic interventions may help change the outcomes of patients with pancreatic cancer.

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Long-Term Survival After Curative Resection for Pancreatic Ductal Adenocarcinoma

Cited by 669 publications

References 29 publications

Clear cell carcinoma of the pancreas: histopathologic features and a unique biomarker: hepatocyte nuclear factor-1β

Clear cell carcinoma of the pancreas: histopathologic features and a unique biomarker: hepatocyte nuclear factor-1β

Impact of caveolin-1 expression on prognosis of pancreatic ductal adenocarcinoma

Improving Survival of Pancreatic Cancer. What Have We Learnt?

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