Yoshihide Nanno1, Ippei Matsumoto2, Yoh Zen3, Kyoko Otani3, Jun Uemura4, Hirochika Toyama1, Sadaki Asari1, Tadahiro Goto1, Tetsuo Ajiki1, Keiichi Okano4, Yasuyuki Suzuki4, Yoshifumi Takeyama5, Takumi Fukumoto1, Yonson Ku1. 1. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 2. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan. ippeimm@gmail.com. 3. Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan. 4. Department of Gastroenterological Surgery, Kagawa University Faculty of Medicine, Takamatsu, Kagawa, Japan. 5. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
Abstract
BACKGROUND: The biological behavior of well-differentiated neuroendocrine tumors of the pancreas (PNETs) is difficult to predict. This study was designed to determine whether involvement of the main pancreatic duct (MPD) serves as a poor prognostic factor for PNETs. METHODS: The involvement of the MPD in PNETs was defined as ductal stenosis inside the tumor mass associated with distal MPDs more than twofold larger in diameter than the proximal ducts. We examined the correlation between MPD involvement and other clinicopathological parameters, including nodal metastasis and recurrence-free survival, in 101 patients treated consecutively at three referral centers in Japan. All patients underwent surgical resection. RESULTS: MPD involvement was observed in 13 of the 101 cases (13%) and was associated with multiple unfavorable clinicopathological features (e.g., larger tumor size, higher histological grade, more frequent nodal metastasis, and higher recurrence rates). Patients with MPD involvement also showed significantly worse recurrence-free survival than did those without ductal involvement (P < 0.001), with a 5 years recurrence-free rate of 41%. On multivariate analysis, MPD involvement was significantly associated with nodal metastasis [odds ratio (OR) 16; 95% confidence interval (CI) 3.8-89; P < 0.001] and recurrence (OR 8.0; 95% CI 1.7-46; P = 0.009). The radiology-pathology correlation revealed that stenosis of the MPD was due to periductal and/or intraductal tumor invasion. Cases with MPD involvement had microscopic venous invasion (P = 0.010) and perineural infiltration (P = 0.002) more frequently than did those with no ductal infiltration. CONCLUSIONS: MPD involvement in PNETs may serve as an imaging sign indicating an aggressive clinical course.
BACKGROUND: The biological behavior of well-differentiated neuroendocrine tumors of the pancreas (PNETs) is difficult to predict. This study was designed to determine whether involvement of the main pancreatic duct (MPD) serves as a poor prognostic factor for PNETs. METHODS: The involvement of the MPD in PNETs was defined as ductal stenosis inside the tumor mass associated with distal MPDs more than twofold larger in diameter than the proximal ducts. We examined the correlation between MPD involvement and other clinicopathological parameters, including nodal metastasis and recurrence-free survival, in 101 patients treated consecutively at three referral centers in Japan. All patients underwent surgical resection. RESULTS: MPD involvement was observed in 13 of the 101 cases (13%) and was associated with multiple unfavorable clinicopathological features (e.g., larger tumor size, higher histological grade, more frequent nodal metastasis, and higher recurrence rates). Patients with MPD involvement also showed significantly worse recurrence-free survival than did those without ductal involvement (P < 0.001), with a 5 years recurrence-free rate of 41%. On multivariate analysis, MPD involvement was significantly associated with nodal metastasis [odds ratio (OR) 16; 95% confidence interval (CI) 3.8-89; P < 0.001] and recurrence (OR 8.0; 95% CI 1.7-46; P = 0.009). The radiology-pathology correlation revealed that stenosis of the MPD was due to periductal and/or intraductal tumor invasion. Cases with MPD involvement had microscopic venous invasion (P = 0.010) and perineural infiltration (P = 0.002) more frequently than did those with no ductal infiltration. CONCLUSIONS: MPD involvement in PNETs may serve as an imaging sign indicating an aggressive clinical course.
Authors: Masayuki Tanaka; Max Heckler; André L Mihaljevic; Pascal Probst; Ulla Klaiber; Ulrike Heger; Simon Schimmack; Markus W Büchler; Thilo Hackert Journal: Ann Surg Oncol Date: 2020-07-27 Impact factor: 5.344
Authors: Samuel J Galgano; Ajaykumar C Morani; Dheeraj R Gopireddy; Kedar Sharbidre; David D B Bates; Ajit H Goenka; Hina Arif-Tiwari; Malak Itani; Amir Iravani; Sanaz Javadi; Silvana Faria; Chandana Lall; Emily Bergsland; Sadhna Verma; Isaac R Francis; Daniel M Halperin; Deyali Chatterjee; Priya Bhosale; Motoyo Yano Journal: Abdom Radiol (NY) Date: 2022-03-04