Microscopic Venous Invasion in Pancreatic Cancer

Yamada, Minoru; Sugiura, Teiichi; Okamura, Yukiyasu; Ito, Takaaki; Yamamoto, Yusuke; Ashida, Ryo; Sasaki, Keiko; Nagino, Masato; Uesaka, Katsuhiko

doi:10.1245/s10434-017-6324-2

Cited by 34 publications

(38 citation statements)

References 31 publications

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“…In our study, MVI appears to be one of the most important determinants of the evolution of pancreatic cancer. Its presence is not uncommon as it was identified in 44% of patients in our series and 64.5% in the retrospective series reported by Yamada et al, reflecting the rapid systemic spread of this disease. Consideration of this factor therefore seems to be fundamental in guiding therapeutic decisions for this cancer.…”

Section: Discussionsupporting

confidence: 60%

“…To date, only one Japanese study highlights the relationship between MVI and the natural history of pancreatic cancer. In fact, Yamada et al found that MVI was a significant prognostic factor in pancreatic cancer. Based on their analysis, MVI exhibits the same prognostic impact as LN metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…The pathological protocol also included the maximal transverse diameter of the tumor, the tumor‐node‐metastasis (TNM) classification, the grade of differentiation, the presence or absence of perineural spread, and the number of lymph nodes retrieved from the specimen, enabling calculations of the lymph node ratio (LNR). The presence of vascular embolism is define by identifying a cluster of intravascular cancer cells away from the primary tumor, unrelated to a direct extension . The presence and grading of preneoplastic lesions were also recorded.…”

Section: Methodsmentioning

confidence: 99%

“…The presence of vascular embolism is define by identifying a cluster of intravascular cancer cells away from the primary tumor, unrelated to a direct extension. 3 The presence and grading of preneoplastic lesions were also recorded. In PV-SMVR, the length of the resection was recorded, and the margins of the vessel segment were examined.…”

Section: Pathological Assessmentmentioning

confidence: 99%

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Microvascular invasion is a major prognostic factor after pancreatico‐duodenectomy for adenocarcinoma

Panaro

Kellil

Vendrell

et al. 2019

Journal of Surgical Oncology

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Background Microvascular invasion (MVI) has been proved to be poor prognostic factor in many cancers. To date, only one study published highlights the relationship between this factor and the natural history of pancreatic cancer. The aim of this study was to assess the impact of MVI, on disease‐free survival (DFS) and overall survival (OS), after pancreatico‐duodenectomy (PD) for pancreatic head adenocarcinoma. Secondarily, we aim to demonstrate that MVI is the most important factor to predict OS after surgery compared with resection margin (RM) and lymph node (LN) status. Materials and Methods Between January 2015 and December 2017, 158 PD were performed in two hepato‐bilio‐pancreatic (HBP) centers. Among these, only 79 patients fulfilled the inclusion criteria of the study. Clinical‐pathological data and outcomes were retrospectively analyzed from a prospectively maintained database. Results Of the 79 patients in the cohort, MVI was identified in 35 (44.3%). In univariate analysis, MVI (P = .012 and P < .0001), RM (P = .023 and P = .021), and LN status (P < .0001 and P = .0001) were significantly associated with DFS and OS. A less than 1 mm margin clearance did not influence relapse (P = .72) or long‐term survival (P = .48). LN ratio > 0.226 had a negative impact on OS (P = .044). In multivariate analysis, MVI and RM persisted as independent prognostic factors of DFS (P = .0075 and P = .0098, respectively) and OS (P < .0001 and P = .0194, respectively). Using the likelihood ratio test, MVI was identified as the best fit to predict OS after PD for ductal adenocarcinomas compared with the margin status model (R0 vs R1) (P = .0014). Conclusion The MVI represents another major prognostic factor determining long‐term outcomes.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Pathological Assessmentmentioning

confidence: 99%

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Microvascular invasion is a major prognostic factor after pancreatico‐duodenectomy for adenocarcinoma

Panaro

Kellil

Vendrell

et al. 2019

Journal of Surgical Oncology

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“…Several studies showed a signi cant impact surgical margins extent on local recurrence and consequently on survival [7][8][9]. Also the relationship between survival outcomes and other prognostic factors have been analyzed such as pre-and post-surgical Ca 19.9 levels, tumor dimension, positive lymph-node status , LVSI and PNI evidence at pathological examination [7,27,[35][36][37][38][39][40].…”

Section: Discussionmentioning

confidence: 99%

Role of Chemoradiation (CRT) in the Adjuvant Treatment of Radically Resected Pancreatic Cancer (PC) Patients: A Mono-Institutional Retrospective Analysis.

Mattiucci

Salvatore

D’Aviero

et al. 2020

Preprint

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BackgroundPancreatic cancer (PC) represents an unfavorable prognosis disease, even in patients with resectable disease. The aim of this series was to investigate the role of treatment intensification with adjuvant chemoradiation (CRT) in radically resected PC patients. MethodsData from PC patients undergone radical surgery, adjuvant chemotherapy (CT) and CRT throughout a 20-year period were retrospectively collected. Actuarial local control (LC) and the overall survival (OS) were the primary endpoints, while secondary end-points were the disease-free-survival (DFS) and metastases-free-survival (MFS). ResultsThe analysis included 108 PC patients treated with adjuvant CRT and CT from January 2000 to August 2019. Median age was 66 years (range: 40-83), all patients underwent radical surgical resection with adjuvant chemotherapy (88, 81,5%) plus concomitant chemoradiation (101, 93,5%) or radiotherapy alone (7, 6,5%). The median dose delivered on tumor bed was 50,4 Gy (range: 45-50,6 Gy), while median dose on regional lymphatic drainage stations was 39,6 Gy (range 39,6-45 Gy. Concomitant CT was gemcitabine-based regimen in the vast majority of patients (87, 80.6%). Median follow-up time was 21 months; the 2- and 5-years LC rate were 75,8% and 59,1%, respectively. Perineural invasion (PNI) at pathological assessment was found significantly associated to LC (p=0.028). Median OS was 40 months with 2- and 5-years OS rate of 73.9% and 41,6 % respectively.ConclusionsThe outcomes of this series strongly suggest that the impact of adjuvant CRT should be deeply investigated in PC patients. Timing, combination of modern CRT with new systemic therapies need to be further investigated to personalize therapy and optimize clinical advantages.

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Why is pancreatic cancer so deadly? The pathologist's view

Hruban

Gaida

Thompson

et al. 2019

The Journal of Pathology

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The remarkable aggressiveness of pancreatic cancer has never been fully explained. Although clearly multifactorial, we postulate that venous invasion, a finding seen in most pancreatic cancers but not in most cancers of other organs, may be a significant, underappreciated contributor to the aggressiveness of this disease. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

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Microscopic Venous Invasion in Pancreatic Cancer

Cited by 34 publications

References 31 publications

Microvascular invasion is a major prognostic factor after pancreatico‐duodenectomy for adenocarcinoma

Microvascular invasion is a major prognostic factor after pancreatico‐duodenectomy for adenocarcinoma

Role of Chemoradiation (CRT) in the Adjuvant Treatment of Radically Resected Pancreatic Cancer (PC) Patients: A Mono-Institutional Retrospective Analysis.

Why is pancreatic cancer so deadly? The pathologist's view

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