Prognostic Value of Peritoneal Lavage Cytology in Patients with Pancreatic Ductal Adenocarcinoma Stratified by the Resectability Status

Sakoda, Takuya; Uemura, Kenichiro; Kondo, Naru; Sumiyoshi, Tatsuaki; Okada, Kenjiro; Seo, Shingo; Otsuka, Hiroyuki; Murakami, Yoshiaki; Takahashi, Shinya

doi:10.1007/s11605-021-04978-3

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…However, a meta-analysis by Cao et al (23) revealed that CY1 was associated with an advanced tumor stage and a poor prognosis, and that radical resection should not be performed in such patients with PDAC. In this study, patients with CY1 had a significantly worse survival than those with CY0, and AC was associated with a longer survival in both groups, which was compatible with the results in recent studies (9,11). Adjuvant therapy is considered an important factor in prolonging the survival of patients with PDAC and CY1.…”

Section: Discussionsupporting

confidence: 91%

“…The clinical implications of CY in pancreatic cancer have been debated over the past few decades. Although some studies suggest that a positive CY result is not associated with adverse outcomes and that resection is still recommended (2, 3), many others have indicated that a positive CY result is associated with a poor prognosis for patients who undergo surgery (4)(5)(6)(7)(8)(9)(10)(11)(12). According to the American Joint Committee on Cancer and the National Comprehensive Cancer Network (NCCN) guidelines, a positive CY result is defined as M1 disease (13,14).…”

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confidence: 99%

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Prognostic Value of Peritoneal Lavage Cytology in Potentially Resectable Pancreatic Cancer Stratified by Cytologic Status

ISHIDA¹,

OGURA²,

TAKAHASHI³

et al. 2023

CDP

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Background/Aim: Patients with pancreatic ductal adenocarcinoma (PDAC) with positive peritoneal lavage cytology (CY) reportedly have poor prognoses. However, the value of diagnosis of suspicious for malignancy on CY is unknown. This study aimed to elucidate the prognostic impact of CY by focusing on CY subgroups. Patients and Methods: Data were collected from 231 resectable PDAC patients who underwent curative-intent resection. Patients were divided into three CY-based groups: negative (CY0), suspicious for malignancy (CY-S), and positive (CY1). Clinicopathological characteristics and prognostic factors were analyzed. Results: CY1 and CY-S were diagnosed in 7.8% and 3.9% of the patients, respectively. The CY1 group had significantly larger tumors and higher frequencies of distal tumors, anterior pancreatic tissue invasion, retropancreatic tissue invasion, and R1 resection than the CY0 group. Patient characteristics did not differ between the CY0 and CY-S groups. The CY1 group exhibited worse survival than the CY0 and CY-S groups (median survival time: 18.8 vs. 39.6 months, p=0.0021 and vs. 62.2 months, p=0.018). Multivariate analysis for survival indicated that a tumor size >2 cm, preoperative CA19-9 value >100 U/ml, CY1, lymph node metastasis, R1 resection, and lack of adjuvant chemotherapy were associated with poor prognosis. Both the CY1 and CY-S groups had higher frequencies of peritoneal recurrence than the CY0 group (50% vs. 11.8%, p<0.001 and 44.4% vs. 11.8%, p=0.019). Conclusion: The prognosis of the CY1 group was poor. Although CY-S was associated with a higher frequency of peritoneal recurrence than CY0, the long-term outcomes of patients with surgical treatment were acceptable.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Prognostic Value of Peritoneal Lavage Cytology in Potentially Resectable Pancreatic Cancer Stratified by Cytologic Status

ISHIDA¹,

OGURA²,

TAKAHASHI³

et al. 2023

CDP

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“…CY+ is widely known to be a prognostic factor for gastric cancer, 18 and in patients with gastric cancer, CY+ is diagnosed as distant metastasis. In contrast, the association between CY+ and prognosis for PC [1][2][3][4][5][6][7][8] and BTC [9][10][11] is controversial. For PC, cytology has recently been considered one of the factors that should be evaluated for tumor staging; and CY+ has been defined as M1 by the American Joint Committee on Cancer (AJCC), 19 the TNM staging system of the Union for International Cancer Control (UICC), 15 and the National Comprehensive Cancer Network (NCCN) guidelines.…”

Section: Prognostic Impact Of the Lc-1000mentioning

confidence: 99%

“…Intraoperative peritoneal cytology can detect malignant cells by microscopy inspection of Papanicolaou‐stained specimens of ascites or peritoneal lavage fluid extracted after laparotomy. The proportion of positive cytology (CY+) has been reported to be 5.4%–30% for pancreatic cancer (PC) 1–8 and 3.0%–9.8% for biliary tract cancer (BTC) 9–11 . However, in conventional diagnosis based on cytomorphology, there were not a few cases unavoidably diagnosed as “suspicious” because of the confounding effects of degenerated cells and reactive mesothelial cells that are difficult to distinguish from malignant cells, or because of the small number of cells that could be judged as malignant.…”

Section: Introductionmentioning

confidence: 99%

LC‐1000 flow cytometry system complements intraoperative peritoneal cytology for pancreatic and biliary tract cancer

Asakura,

Ajiki,

Abe

et al. 2023

J Hepato Biliary Pancreat

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BackgroundThe exfoliative cell analyzer, LC‐1000, is medical device that utilizes the principles of flow cytometry, and might provide digital diagnostic information for cytology using a different approach from conventional cytomorphology. In this study, wae examined the usefulness of the LC‐1000 as a diagnostic support system for intraoperative peritoneal lavage cytology and its prognostic impact for pancreatic (PC) and biliary tract cancer (BTC).MethodsPatients with PC and BTC who underwent surgical treatment were included. First, we identified useful indicators of LC‐1000 and established cutoff values to discriminate positive cytology. Next, we verified the validity of these cutoff values.ResultsIn the test set (n = 48), of the LC‐1000 indicators examined, only MR‐CPIx was significantly different between the negative and positive cytology groups, yielding a cutoff value of 0.86. In the validation set (n = 52), the sensitivity, specificity, positive and negative predictive value of the LC‐1000 for cytology results was 1.0, 0.49, 0.11 and 1.0, respectively. In patients who had undergone radical resection, recurrence‐free survival rate was significantly higher in the LC‐1000 negative group than in the positive group in PC, but not in BTC.ConclusionThe LC‐1000 was useful as digital support system for peritoneal cytology, and it might have potential as a prognostic factor for PC.

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“…The cut-off for hemoglobin A1c was 6.4% based on the upper limit of normal at our institution. The cut-off for tumor size, NLR, PLR, PNI, and preoperative CA19-9 were 20 mm, 3, 150, 45, and 100 U/mL, respectively, which were determined according to previous reports demonstrating their prognostic impact [5,[7][8][9][10][11][12][13]. 1.…”

Section: Roc Curves For Preoperative Continuous Variablesmentioning

confidence: 99%

Identification of Preoperative Risk Factors for Poor Survival in Patients with Resectable Pancreatic Cancer Treated with Upfront Surgery

et al. 2021

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Introduction: The aim of this study was to identify preoperative risk factors for poor survival in patients with resectable pancreatic ductal adenocarcinoma (PDAC) treated with upfront surgery. Methods: Medical records of 268 patients with resectable PDAC defined by resectability status who underwent upfront surgery were reviewed retrospectively. Multivariate analyses were performed to identify preoperative risk factors for recurrence-free survival (RFS) and overall survival (OS). Moreover, a binary logistic regression model was built to determine preoperative independent risk factors of 2- and 3-year recurrence and survival. Results: Multivariate analyses identified CA19-9 (≥100 U/mL, p < 0.001) as an independent risk factor for poor RFS, and worse performance status (1 or 2, p = 0.03), platelet:lymphocyte ratio (<150, p = 0.04), and preoperative CA19-9 (≥100 U/mL, p < 0.001) as independent risk factors for poor OS. Moreover, preoperative CA19-9 (≥100 U/mL) was the only independent risk factor identified for 2- and 3-year recurrence and survival. Discussion/Conclusion: Preoperative CA19-9 (≥100 U/mL) was the most reliable preoperative predictive factor for poor survival in resectable PDAC treated with upfront surgery. These findings warrant further clinical trials investigating efficacy of neoadjuvant therapy targeting the subset of patients with resectable PDAC who have elevated preoperative CA19-9, namely, those with high risk of poor prognosis.

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Prognostic Value of Peritoneal Lavage Cytology in Patients with Pancreatic Ductal Adenocarcinoma Stratified by the Resectability Status

Cited by 7 publications

References 23 publications

Prognostic Value of Peritoneal Lavage Cytology in Potentially Resectable Pancreatic Cancer Stratified by Cytologic Status

Prognostic Value of Peritoneal Lavage Cytology in Potentially Resectable Pancreatic Cancer Stratified by Cytologic Status

LC‐1000 flow cytometry system complements intraoperative peritoneal cytology for pancreatic and biliary tract cancer

Identification of Preoperative Risk Factors for Poor Survival in Patients with Resectable Pancreatic Cancer Treated with Upfront Surgery

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