Tumor Stroma Area and Other Prognostic Factors in Pancreatic Ductal Adenocarcinoma Patients Submitted to Surgery

Abstract

Pancreatic ductal adenocarcinoma (PDAC) has a dense stroma, responsible for up to 80% of its volume. The amount of stroma can be associated with prognosis, although there are discrepancies regarding its concrete impact. The aim of this work was to study prognostic factors for PDAC patients submitted to surgery, including the prognostic impact of the tumor stroma area (TSA). A retrospective study with PDAC patients submitted for surgical resection was conducted. The TSA was calculated using QuPath-0.2.3 software. Arterial hypertension, diabetes mellitus, and surgical complications Clavien–Dindo>IIIa are independent risk factors for mortality in PDAC patients submitted to surgery. Regarding TSA, using >1.9 × 1011 µ2 as cut-off value for all stages, patients seem to have longer overall survival (OS) (31 vs. 21 months, p = 0.495). For stage II, a TSA > 2 × 1011 µ2 was significantly associated with an R0 resection (p = 0.037). For stage III patients, a TSA > 1.9 × 1011 µ2 was significantly associated with a lower histological grade (p = 0.031), and a TSA > 2E + 11 µ2 was significantly associated with a preoperative AP ≥ 120 U/L (p = 0.009) and a lower preoperative AST (≤35 U/L) (p = 0.004). Patients with PDAC undergoing surgical resection with preoperative CA19.9 > 500 U/L and AST ≥ 100 U/L have an independent higher risk of recurrence. Tumor stroma could have a protective effect in these patients. A larger TSA is associated with an R0 resection in stage II patients and a lower histological grade in stage III patients, which may contribute to a longer OS.

The Impact of Preoperative Biliary Drainage on Postoperative Healthcare-Associated Infections and Clinical Outcomes Following Pancreaticoduodenectomy: A Ten-Year Retrospective Analysis

“…Previous studies on PBD have shown con icting results regarding the increased risk of infectious complications [14,31,[40][41][42]. In our study, we did not nd a signi cant increase in postoperative HAIs incidence associated with PBD.…”

The cross-talk between the macro and micro-environment in precursor lesions of pancreatic cancer leads to new and promising circulating biomarkers

“…Although these biomarkers are not related to host-periphery crosstalk, once combined with TIME-TIMaE crosstalk mediating molecules, could be considered an invaluable tool for diagnostics and clinical evaluation of PC patients, already at early stages. The most frequently used and most widely validated biomarker is CA 19–9, but, due to its low specificity and high false positive and negative rate, CA 19–9 is not sufficiently reliable as a diagnostic marker in clinical practice [ 128 ]. For this reason, some studies have focused on the combined detection of CA19-9 together with other tumor markers such as carcino-embryonic antigen (CEA), carbohydrate antigen 125 (CA125), carbohydrate antigen 242 (CA242), and on novel serum biomarkers [ 129 ], microRNAs [ 130 ] or new imaging techniques such as endoscopic retrograde cholangio pancreatography and endoscopic ultrasonography [ 131 , 132 ].…”