Top

BMC Cancer

Published in:

Open Access 01-12-2018 | Research article

Impact of tumor size on survival of patients with resected pancreatic ductal adenocarcinoma: a systematic review and meta-analysis

Authors: Debang Li, Bin Hu, Yanming Zhou, Tao Wan, Xiaoying Si

Published in: BMC Cancer | Issue 1/2018

Abstract

Background

The impact of tumor size on prognosis for surgically treated patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. A systematic review and meta-analysis was performed to evaluate this issue.

Methods

Relevant studies published from January 2000 to June 2017 were identified through EMBASE and PUBMED. Data were pooled for meta-analysis using Review Manager 5.3.

Results

Twenty eight observational studies involving a total of 23,945 patients were included. Tumors > 2 cm was associated with poor prognosis: the pooled hazard ratio (HR) estimate for overall survival was 1.52 (95% confidence interval [CI]: 1.41–1.64; P < 0.0001) by univariate analysis and 1.61 (95% CI: 1.35–1.91; P < 0.0001) by multivariate analysis; the pooled HR estimate for disease-free survival was 1.74 (95% CI: 1.46–2.07; P < 0.0001) by univariate analysis and 1.38 (95% CI: 1.12–1.68; P = 0.002) by multivariate analysis. When compared with patients with tumors ≤2 cm, those with the tumors > 2 cm had higher incidences of lymph node metastasis, poor tumor differentiation, lymph vessel invasion, vascular invasion, perineural invasion, and positive intraoperative peritoneal cytology.

Conclusion

These data demonstrate that PDAC size > 2 cm is an independent predictive factor for poor prognosis after surgical resection and associated with more aggressive tumor biology.

Strobel O, Hinz U, Gluth A, Hank T, Hackert T, Bergmann F, et al. Pancreatic adenocarcinoma: number of positive nodes allows to distinguish several N categories. Ann Surg. 2015;261:961–9. https://doi.org/10.1097/SLA.0000000000000814.CrossRefPubMed

Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004;91:586–94. https://doi.org/10.1002/bjs.4484.CrossRefPubMed

Crippa S, Partelli S, Zamboni G, Barugola G, Capelli P, Inama M, et al. Poorly differentiated resectable pancreatic cancer: is upfront resection worthwhile? Surgery. 2012;152:S112–9. https://doi.org/10.1016/j.surg.2012.05.017.CrossRefPubMed

Allen PJ, Kuk D, Castillo CF, Basturk O, Wolfgang CL, Cameron JL, et al. Multi-institutional validation study of the American joint commission on Cancer (8th edition) changes for T and N staging in patients with pancreatic adenocarcinoma. Ann Surg. 2017;265:185–91. https://doi.org/10.1097/SLA.0000000000001763.CrossRefPubMedPubMedCentral

de Jong MC, Li F, Cameron JL, Wolfgang CL, Edil BH, Herman JM, et al. Re-evaluating the impact of tumor size on survival following pancreaticoduodenectomy for pancreatic adenocarcinoma. J Surg Oncol. 2011;103:656–62. https://doi.org/10.1002/jso.21883.CrossRefPubMedPubMedCentral

Marchegiani G, Andrianello S, Malleo G, De Gregorio L, Scarpa A, Mino-Kenudson M, et al. Does size matter in pancreatic Cancer?: reappraisal of tumour dimension as a predictor of outcome beyond the TNM. Ann Surg. 2017;266:142–8. https://doi.org/10.1097/SLA.0000000000001837.CrossRefPubMed

Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA group: preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRef

Zhu JC, Yan TD, Morris DL. A systematic review of radiofrequency ablation for lung tumors. Ann Surg Oncol. 2008;15:1765–74. https://doi.org/10.1245/s10434-008-9848-7.CrossRefPubMed

Meyer W, Jurowich C, Reichel M, Steinhäuser B, Wünsch PH, Gebhardt C. Pathomorphological and histological prognostic factors in curatively resected ductal adenocarcinoma of the pancreas. Surg Today. 2000;30:582–7. https://doi.org/10.1007/s005950070096.CrossRefPubMed

10.

Ahmad NA, Lewis JD, Ginsberg GG, Haller DG, Morris JB, Williams NN, et al. Long term survival after pancreatic resection for pancreatic adenocarcinoma. Am J Gastroenterol. 2001;96:2609–15. https://doi.org/10.1111/j.1572-0241.2001.04123.x.CrossRefPubMed

11.

Kim J, Reber HA, Dry SM, Elashoff D, Chen SL, Umetani N, et al. Unfavourable prognosis associated with K-ras gene mutation in pancreatic cancer surgical margins. Gut. 2006;55:1598–605. https://doi.org/10.1136/gut.2006.098814.CrossRefPubMedPubMedCentral

12.

Smith RA, Bosonnet L, Ghaneh P, Raraty M, Sutton R, Campbell F, et al. Preoperative CA19-9 levels and lymph node ratio are independent predictors of survival in patients with resected pancreatic ductal adenocarcinoma. Dig Surg. 2008;25:226–32. https://doi.org/10.1159/000140961.CrossRefPubMed

13.

Chang DK, Johns AL, Merrett ND, Gill AJ, Colvin EK, Scarlett CJ, et al. Margin clearance and outcome in resected pancreatic cancer. J Clin Oncol. 2009;27:2855–62. https://doi.org/10.1200/JCO.2008.20.5104.CrossRefPubMed

14.

Chiang KC, Yeh CN, Lee WC, Jan YY, Hwang TL. Prognostic analysis of patients with pancreatic head adenocarcinoma less than 2 cm undergoing resection. World J Gastroenterol. 2009;15:4305–10. https://doi.org/10.3748/wjg.15.4305.CrossRefPubMedPubMedCentral

15.

Kato K, Yamada S, Sugimoto H, Kanazumi N, Nomoto S, Takeda S, et al. Prognostic factors for survival after extended pancreatectomy for pancreatic head cancer: influence of resection margin status on survival. Pancreas. 2009;38:605–12. https://doi.org/10.1097/MPA.0b013e3181a4891d.CrossRefPubMed

16.

Massucco P, Ribero D, Sgotto E, Mellano A, Muratore A, Capussotti L. Prognostic significance of lymph node metastases in pancreatic head cancer treated with extended lymphadenectomy: not just a matter of numbers. Ann Surg Oncol. 2009;16:3323–32. https://doi.org/10.1245/s10434-009-0672-5.CrossRefPubMed

17.

Bhatti I, Peacock O, Awan AK, Semeraro D, Larvin M, Hall RI. Lymph node ratio versus number of affected lymph nodes as predictors of survival for resected pancreatic adenocarcinoma. World J Surg. 2010;34:768–75. https://doi.org/10.1007/s00268-009-0336-4.CrossRefPubMed

18.

Cannon RM, LeGrand R, Chagpar RB, Ahmad SA, McClaine R, Kim HJ, et al. Multi-institutional analysis of pancreatic adenocarcinoma demonstrating the effect of diabetes status on survival after resection. HPB (Oxford). 2012;14:228–35. https://doi.org/10.1111/j.1477-2574.2011.00432.x.CrossRef

19.

Petermann D, Demartines N, Schäfer M. Is tumour size an underestimated feature in the current TNM system for malignancies of the pancreatic head? HPB (Oxford). 2013;15:872–81. https://doi.org/10.1111/hpb.12052.CrossRef

20.

Yamada S, Fujii T, Kanda M, Sugimoto H, Nomoto S, Takeda S, et al. Value of peritoneal cytology in potentially resectable pancreatic cancer. Br J Surg. 2013;100:1791–6. https://doi.org/10.1002/bjs.9307.CrossRefPubMed

21.

Buc E, Couvelard A, Kwiatkowski F, Dokmak S, Ruszniewski P, Hammel P, et al. Adenocarcinoma of the pancreas: does prognosis depend on mode of lymph node invasion? Eur J Surg Oncol. 2014;40:1578–85. https://doi.org/10.1016/j.ejso.2014.04.012.CrossRefPubMed

22.

Elberm H, Ravikumar R, Sabin C, Abu Hilal M, Al-Hilli A, Aroori S, et al. Outcome after pancreaticoduodenectomy for T3 adenocarcinoma: a multivariable analysis from the UK vascular resection for pancreatic Cancer study group. Eur J Surg Oncol. 2015;41:1500–7. https://doi.org/10.1016/j.ejso.2015.08.158.CrossRefPubMed

23.

Iwagami Y, Eguchi H, Wada H, Tomimaru Y, Hama N, Kawamoto K, et al. Implications of peritoneal lavage cytology in resectable left-sided pancreatic cancer. Surg Today. 2015;45:444–50. https://doi.org/10.1007/s00595-014-0964-7.CrossRefPubMed

24.

Liu L, Katz MH, Lee SM, Fischer LK, Prakash L, Parker N, et al. Superior mesenteric artery margin of Posttherapy Pancreaticoduodenectomy and prognosis in patients with pancreatic ductal adenocarcinoma. Am J Surg Pathol. 2015;39:1395–403. https://doi.org/10.1097/PAS.0000000000000491.CrossRefPubMed

25.

Okumura S, Kaido T, Hamaguchi Y, Fujimoto Y, Masui T, Mizumoto M, et al. Impact of preoperative quality as well as quantity of skeletal muscle on survival after resection of pancreatic cancer. Surgery. 2015;157:1088–98. https://doi.org/10.1016/j.surg.2015.02.002.CrossRefPubMed

26.

Yamamoto T, Yagi S, Kinoshita H, Sakamoto Y, Okada K, Uryuhara K, et al. Long-term survival after resection of pancreatic cancer: a single-center retrospective analysis. World J Gastroenterol. 2015;21:262–8. https://doi.org/10.3748/wjg.v21.i1.262.CrossRefPubMedPubMedCentral

27.

Lin JY, Zhang XM, Kou JT, Fa H, Zhang XX, Dai Y, He Q. Analysis of prognostic factors for pancreatic head cancer according to Para-aortic lymph node. Cancer Med. 2016;5:2701–7. https://doi.org/10.1002/cam4.853.CrossRefPubMedPubMedCentral

28.

Abe T, Ohuchida K, Endo S, Ookubo F, Mori Y, Nakata K, et al. Clinical importance of intraoperative peritoneal cytology in patients with pancreatic cancer. Surgery. 2017;161:951–8. https://doi.org/10.1016/j.surg.2016.10.035.CrossRefPubMed

29.

Ansari D, Bauden M, Bergström S, Rylance R, Marko-Varga G, Andersson R. Relationship between tumour size and outcome in pancreatic ductal adenocarcinoma. Br J Surg. 2017;104:600–7. https://doi.org/10.1002/bjs.10471.CrossRefPubMed

30.

Chikamoto A, Inoue R, Komohara Y, Sakamaki K, Hashimoto D, Shiraishi S, et al. Preoperative high maximum standardized uptake value in association with glucose transporter 1 predicts poor prognosis in pancreatic Cancer. Ann Surg Oncol. 2017;24:2040–6. https://doi.org/10.1245/s10434-017-5799-1.CrossRefPubMed

31.

Kurata M, Honda G, Murakami Y, Uemura K, Satoi S, Motoi F, et al. Multicenter study Group of Pancreatobiliary Surgery (MSG-PBS): retrospective study of the correlation between pathological tumor size and survival after curative resection of T3 pancreatic adenocarcinoma: proposal for reclassification of the tumor extending beyond the pancreas based on tumor size. World J Surg. 2017 Jun 15. https://doi.org/10.1007/s00268-017-4077-5.CrossRef

32.

Le AT, Huang B, Hnoosh D, Saeed H, Dineen SP, Hosein PJ, Durbin EB, et al. Effect of complications on oncologic outcomes after pancreaticoduodenectomy for pancreatic cancer. J Surg Res. 2017;214:1–8. https://doi.org/10.1016/j.jss.2017.02.036.CrossRefPubMed

33.

Watanabe Y, Nishihara K, Matsumoto S, Okayama T, Abe Y, Nakano T. Effect of postoperative major complications on prognosis after pancreatectomy for pancreatic cancer: a retrospective review. Surg Today. 2017;47:555–67. https://doi.org/10.1007/s00595-016-1426-1.CrossRefPubMed

34.

Yu R, Li C, Lin X, Chen Q, Li J, Song L, et al. Clinicopathologic features and prognostic implications of MYBL2 protein expression in pancreatic ductal adenocarcinoma. Pathol Res Pract. 2017;213:964–8. https://doi.org/10.1016/j.prp.2017.04.024.CrossRefPubMed

35.

Morganti AG, Brizi MG, Macchia G, Sallustio G, Costamagna G, Alfieri S, et al. The prognostic effect of clinical staging in pancreatic adenocarcinoma. Ann Surg Oncol. 2005;12:145–51. https://doi.org/10.1245/ASO.2005.02.021.CrossRefPubMed

36.

Agarwal B, Correa AM, Ho L. Survival in pancreatic carcinoma based on tumor size. Pancreas. 2008;36:e15–20. https://doi.org/10.1097/mpa.0b013e31814de421.CrossRefPubMed

37.

Dusch N, Weiss C, Ströbel P, Kienle P, Post S, Niedergethmann M. Factors predicting long-term survival following pancreatic resection for ductal adenocarcinoma of the pancreas: 40 years of experience. J Gastrointest Surg. 2014;18:674–81. https://doi.org/10.1007/s11605-013-2408-x.CrossRefPubMed

38.

Schorn S, Demir IE, Reyes CM, Saricaoglu C, Samm N, Schirren R, et al. The impact of neoadjuvant therapy on the histopathological features of pancreatic ductal adenocarcinoma - a systematic review and meta-analysis. Cancer Treat Rev. 2017;55:96–106. https://doi.org/10.1016/j.ctrv.2017.03.003.CrossRefPubMed

Title: Impact of tumor size on survival of patients with resected pancreatic ductal adenocarcinoma: a systematic review and meta-analysis
Authors: Debang Li
Bin Hu
Yanming Zhou
Tao Wan
Xiaoying Si
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-018-4901-9

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Usefulness of combined androgen blockade therapy with gonadotropin-releasing hormone antagonist for bone metastatic prostate cancer with pretreatment prostate-specific antigen level ≥ 50 ng/mL

The impact of the tumor shrinkage by initial EGFR inhibitors according to the detection of EGFR-T790M mutation in patients with non-small cell lung cancer harboring EGFR mutations

Using a nomogram based on preoperative serum fibrinogen levels to predict recurrence of papillary thyroid carcinoma

Diagnostic role of circulating extracellular matrix-related proteins in non-small cell lung cancer

Impact of CDX2 expression status on the survival of patients after curative resection for colorectal cancer liver metastasis

Single-stranded DNA binding protein 2 expression is associated with patient survival in hepatocellular carcinoma

Keynote webinar | Spotlight on antibody–drug conjugates in cancer