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Published in: Journal of Gastrointestinal Surgery 10/2017

01-10-2017 | Original Article

Prospective Evaluation of Associations between Cancer-Related Pain and Perineural Invasion in Patients with Resectable Pancreatic Adenocarcinoma

Authors: Rosalie A. Carr, Alexandra M. Roch, Xin Zhong, Eugene P. Ceppa, Nicholas J. Zyromski, Attila Nakeeb, C. Max Schmidt, Michael G. House

Published in: Journal of Gastrointestinal Surgery | Issue 10/2017

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Abstract

Introduction

Perineural invasion is a unique characteristic of pancreatic adenocarcinoma biology and is present in the majority of resected pathologic specimens. The purpose of this study was to understand the relationships between preoperative pain and perineural invasion in patients with pancreatic adenocarcinoma.

Methods

Fifty-two chemotherapy naive patients undergoing resection for pancreatic adenocarcinoma from 2012 to 2014 completed a previously validated Brief Pain Inventory survey for preoperative clinical pain scoring. Preoperative pain was correlated with multiple clinicopathologic features.

Results

Preoperative pain was not associated with pathologic cancer stage, lymph node status, lymph node positivity ratio, resection margin status, or tumor location within the pancreas. In the subgroup of pancreatic head cancers, pain interference with affect was associated with the absence of perineural invasion (p = 0.02). Patients with stage I cancer had higher pain interference scores than those with stage II cancer (p = 0.02).

Conclusions

Preoperative pain does not predict the presence of perineural invasion or other pathologic prognostic factors in patients with resectable pancreatic adenocarcinoma. Higher pain scores in pancreatic head cancers correlated with absence of perineural invasion and early cancer stage. The effects of preoperative pain on quality and interference of daily life deserve further investigation in larger prospective studies involving patients with pancreatic cancer.
Literature
1.
go back to reference Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J. Clin. 2011; 61: 212–36.CrossRefPubMed Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J. Clin. 2011; 61: 212–36.CrossRefPubMed
3.
go back to reference Pour PM, Bell RH, Batra SK. Neural invasion in the staging of pancreatic cancer. Pancreas 2003; 26: 322–5.CrossRefPubMed Pour PM, Bell RH, Batra SK. Neural invasion in the staging of pancreatic cancer. Pancreas 2003; 26: 322–5.CrossRefPubMed
4.
go back to reference Ceyhan GO, Demir IE, Altintas B, et al. Neural invasion in pancreatic cancer: a mutual tropism between neurons and cancer cells. Biochem Biophys Res Commun 2008; 374: 442–7.CrossRefPubMed Ceyhan GO, Demir IE, Altintas B, et al. Neural invasion in pancreatic cancer: a mutual tropism between neurons and cancer cells. Biochem Biophys Res Commun 2008; 374: 442–7.CrossRefPubMed
5.
go back to reference Ceyhan GO, Bergmann F, Kadihasanoglu M, et al. Pancreatic neuropathy and neuropathic pain--a comprehensive pathomorphological study of 546 cases. Gastroenterology 2009; 136: 177–186.e1.CrossRefPubMed Ceyhan GO, Bergmann F, Kadihasanoglu M, et al. Pancreatic neuropathy and neuropathic pain--a comprehensive pathomorphological study of 546 cases. Gastroenterology 2009; 136: 177–186.e1.CrossRefPubMed
6.
go back to reference Kayahara M, Nakagawara H, Kitagawa H, Ohta T. The nature of neural invasion by pancreatic cancer. Pancreas 2007; 35: 218–23.CrossRefPubMed Kayahara M, Nakagawara H, Kitagawa H, Ohta T. The nature of neural invasion by pancreatic cancer. Pancreas 2007; 35: 218–23.CrossRefPubMed
7.
go back to reference Demir IE, Ceyhan GO, Liebl F, et al. Neural invasion in pancreatic cancer: the past, present and future. Cancers (Basel) 2010; 2: 1513–27.CrossRef Demir IE, Ceyhan GO, Liebl F, et al. Neural invasion in pancreatic cancer: the past, present and future. Cancers (Basel) 2010; 2: 1513–27.CrossRef
8.
go back to reference Liebl F, Demir IE, Mayer K, et al. The impact of neural invasion severity in gastrointestinal malignancies: a clinicopathological study. Ann. Surg. 2014; 260: 900–7; discussion 907-8.CrossRefPubMed Liebl F, Demir IE, Mayer K, et al. The impact of neural invasion severity in gastrointestinal malignancies: a clinicopathological study. Ann. Surg. 2014; 260: 900–7; discussion 907-8.CrossRefPubMed
9.
go back to reference Liang D, Shi S, Xu J, et al. New insights into perineural invasion of pancreatic cancer: more than pain. Biochim. Biophys. Acta 2016; 1865: 111–122. Liang D, Shi S, Xu J, et al. New insights into perineural invasion of pancreatic cancer: more than pain. Biochim. Biophys. Acta 2016; 1865: 111–122.
10.
go back to reference Liebig C, Ayala G, Wilks JA, et al. Perineural invasion in cancer: a review of the literature. Cancer 2009; 115: 3379–91.CrossRefPubMed Liebig C, Ayala G, Wilks JA, et al. Perineural invasion in cancer: a review of the literature. Cancer 2009; 115: 3379–91.CrossRefPubMed
11.
go back to reference Yi SQ, Miwa K, Ohta T, et al. Innervation of the pancreas from the perspective of perineural invasion of pancreatic cancer. Pancreas 2003; 27: 225–9.CrossRefPubMed Yi SQ, Miwa K, Ohta T, et al. Innervation of the pancreas from the perspective of perineural invasion of pancreatic cancer. Pancreas 2003; 27: 225–9.CrossRefPubMed
12.
go back to reference Hirai I, Kimura W, Ozawa K, et al. Perineural invasion in pancreatic cancer. Pancreas 2002; 24: 15–25.CrossRefPubMed Hirai I, Kimura W, Ozawa K, et al. Perineural invasion in pancreatic cancer. Pancreas 2002; 24: 15–25.CrossRefPubMed
13.
go back to reference Bapat AA, Hostetter G, Von Hoff DD, Han H. Perineural invasion and associated pain in pancreatic cancer. Nat Rev Cancer 2011; 11: 695–707.CrossRefPubMed Bapat AA, Hostetter G, Von Hoff DD, Han H. Perineural invasion and associated pain in pancreatic cancer. Nat Rev Cancer 2011; 11: 695–707.CrossRefPubMed
14.
go back to reference Ceyhan GO, Schafer KH, Kerscher AG, et al. Nerve growth factor and artemin are paracrine mediators of pancreatic neuropathy in pancreatic adenocarcinoma. Annals of surgery 2010; 251: 923–31.CrossRefPubMed Ceyhan GO, Schafer KH, Kerscher AG, et al. Nerve growth factor and artemin are paracrine mediators of pancreatic neuropathy in pancreatic adenocarcinoma. Annals of surgery 2010; 251: 923–31.CrossRefPubMed
15.
go back to reference Mitsunaga S, Hasebe T, Kinoshita T, et al. Detail histologic analysis of nerve plexus invasion in invasive ductal carcinoma of the pancreas and its prognostic impact. Am. J. Surg. Pathol. 2007; 31: 1636–44.CrossRefPubMed Mitsunaga S, Hasebe T, Kinoshita T, et al. Detail histologic analysis of nerve plexus invasion in invasive ductal carcinoma of the pancreas and its prognostic impact. Am. J. Surg. Pathol. 2007; 31: 1636–44.CrossRefPubMed
16.
go back to reference Shimada K, Nara S, Esaki M, et al. Intrapancreatic nerve invasion as a predictor for recurrence after pancreaticoduodenectomy in patients with invasive ductal carcinoma of the pancreas. Pancreas 2011; 40: 464–8.CrossRefPubMed Shimada K, Nara S, Esaki M, et al. Intrapancreatic nerve invasion as a predictor for recurrence after pancreaticoduodenectomy in patients with invasive ductal carcinoma of the pancreas. Pancreas 2011; 40: 464–8.CrossRefPubMed
17.
go back to reference Takahashi H, Ohigashi H, Ishikawa O, et al. Perineural invasion and lymph node involvement as indicators of surgical outcome and pattern of recurrence in the setting of preoperative gemcitabine-based chemoradiation therapy for resectable pancreatic cancer. Ann. Surg. 2012; 255: 95–102.CrossRefPubMed Takahashi H, Ohigashi H, Ishikawa O, et al. Perineural invasion and lymph node involvement as indicators of surgical outcome and pattern of recurrence in the setting of preoperative gemcitabine-based chemoradiation therapy for resectable pancreatic cancer. Ann. Surg. 2012; 255: 95–102.CrossRefPubMed
18.
go back to reference Perini MV, Montagnini AL, Jukemura J, et al. Clinical and pathologic prognostic factors for curative resection for pancreatic cancer. HPB : the official journal of the International Hepato Pancreato Biliary Association 2008; 10: 356–62.CrossRef Perini MV, Montagnini AL, Jukemura J, et al. Clinical and pathologic prognostic factors for curative resection for pancreatic cancer. HPB : the official journal of the International Hepato Pancreato Biliary Association 2008; 10: 356–62.CrossRef
19.
go back to reference Chatterjee D, Katz MH, Rashid A, et al. Perineural and intraneural invasion in posttherapy pancreaticoduodenectomy specimens predicts poor prognosis in patients with pancreatic ductal adenocarcinoma. Am. J. Surg. Pathol. 2012; 36: 409–17.CrossRefPubMedPubMedCentral Chatterjee D, Katz MH, Rashid A, et al. Perineural and intraneural invasion in posttherapy pancreaticoduodenectomy specimens predicts poor prognosis in patients with pancreatic ductal adenocarcinoma. Am. J. Surg. Pathol. 2012; 36: 409–17.CrossRefPubMedPubMedCentral
20.
go back to reference Nakao A, Harada A, Nonami T, et al. Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer. Pancreas 1996; 12: 357–61.CrossRefPubMed Nakao A, Harada A, Nonami T, et al. Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer. Pancreas 1996; 12: 357–61.CrossRefPubMed
21.
go back to reference Ozaki H, Hiraoka T, Mizumoto R, et al. The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg. Today 1999; 29: 16–22.CrossRefPubMed Ozaki H, Hiraoka T, Mizumoto R, et al. The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg. Today 1999; 29: 16–22.CrossRefPubMed
22.
go back to reference Cameron JL, Crist DW, Sitzmann JV, et al. Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am. J. Surg. 1991; 161: 120–4; discussion 124-5.CrossRefPubMed Cameron JL, Crist DW, Sitzmann JV, et al. Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am. J. Surg. 1991; 161: 120–4; discussion 124-5.CrossRefPubMed
23.
go back to reference Badger SA, Brant JL, Jones C, et al. The role of surgery for pancreatic cancer: a 12-year review of patient outcome. The Ulster medical journal 2010; 79: 70–5.PubMedPubMedCentral Badger SA, Brant JL, Jones C, et al. The role of surgery for pancreatic cancer: a 12-year review of patient outcome. The Ulster medical journal 2010; 79: 70–5.PubMedPubMedCentral
24.
go back to reference Chen JW, Bhandari M, Astill DS, et al. Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion. HPB : the official journal of the International Hepato Pancreato Biliary Association 2010; 12: 101–8.CrossRef Chen JW, Bhandari M, Astill DS, et al. Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion. HPB : the official journal of the International Hepato Pancreato Biliary Association 2010; 12: 101–8.CrossRef
25.
go back to reference Ceyhan GO, Liebl F, Maak M, et al. The severity of neural invasion is a crucial prognostic factor in rectal cancer independent of neoadjuvant radiochemotherapy. Ann. Surg. 2010; 252: 797–804.CrossRefPubMed Ceyhan GO, Liebl F, Maak M, et al. The severity of neural invasion is a crucial prognostic factor in rectal cancer independent of neoadjuvant radiochemotherapy. Ann. Surg. 2010; 252: 797–804.CrossRefPubMed
26.
go back to reference Liebl F, Demir IE, Rosenberg R, et al. The severity of neural invasion is associated with shortened survival in colon cancer. Clin. Cancer Res. 2013; 19: 50–61.CrossRefPubMed Liebl F, Demir IE, Rosenberg R, et al. The severity of neural invasion is associated with shortened survival in colon cancer. Clin. Cancer Res. 2013; 19: 50–61.CrossRefPubMed
28.
go back to reference Tempero MA, Malafa MP, Behrman SW, et al. Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J. Natl. Compr. Canc. Netw. 2014; 12: 1083–93.CrossRefPubMed Tempero MA, Malafa MP, Behrman SW, et al. Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J. Natl. Compr. Canc. Netw. 2014; 12: 1083–93.CrossRefPubMed
29.
go back to reference Grahm AL, Andren-Sandberg A. Prospective evaluation of pain in exocrine pancreatic cancer. Digestion 1997; 58: 542–9.CrossRefPubMed Grahm AL, Andren-Sandberg A. Prospective evaluation of pain in exocrine pancreatic cancer. Digestion 1997; 58: 542–9.CrossRefPubMed
30.
go back to reference Okusaka T, Okada S, Ueno H, et al. Abdominal pain in patients with resectable pancreatic cancer with reference to clinicopathologic findings. Pancreas 2001; 22: 279–84.CrossRefPubMed Okusaka T, Okada S, Ueno H, et al. Abdominal pain in patients with resectable pancreatic cancer with reference to clinicopathologic findings. Pancreas 2001; 22: 279–84.CrossRefPubMed
31.
go back to reference Zhu Z, Friess H, diMola FF, et al. Nerve growth factor expression correlates with perineural invasion and pain in human pancreatic cancer. J. Clin. Oncol. 1999; 17: 2419–28.CrossRefPubMed Zhu Z, Friess H, diMola FF, et al. Nerve growth factor expression correlates with perineural invasion and pain in human pancreatic cancer. J. Clin. Oncol. 1999; 17: 2419–28.CrossRefPubMed
32.
go back to reference Trigui B, Barrier A, Flahault A, Huguier M. Prognostic factors in advanced pancreatic cancer. Multivariate analysis of predictive survival score. University Surgery Association. Ann. Chir. 2000; 125: 625–30.CrossRefPubMed Trigui B, Barrier A, Flahault A, Huguier M. Prognostic factors in advanced pancreatic cancer. Multivariate analysis of predictive survival score. University Surgery Association. Ann. Chir. 2000; 125: 625–30.CrossRefPubMed
33.
go back to reference Muller MW, Friess H, Koninger J, et al. Factors influencing survival after bypass procedures in patients with advanced pancreatic adenocarcinomas. Am. J. Surg. 2008; 195: 221–8.CrossRefPubMed Muller MW, Friess H, Koninger J, et al. Factors influencing survival after bypass procedures in patients with advanced pancreatic adenocarcinomas. Am. J. Surg. 2008; 195: 221–8.CrossRefPubMed
34.
go back to reference Kelsen DP, Portenoy R, Thaler H, et al. Pain as a predictor of outcome in patients with operable pancreatic carcinoma. Surgery 1997; 122: 53–9.CrossRefPubMed Kelsen DP, Portenoy R, Thaler H, et al. Pain as a predictor of outcome in patients with operable pancreatic carcinoma. Surgery 1997; 122: 53–9.CrossRefPubMed
35.
go back to reference Moye J, June A, Martin LA, et al. Pain is prevalent and persisting in cancer survivors: differential factors across age groups. Journal of Geriatric Oncology 2014; 5: 190–6.CrossRefPubMedPubMedCentral Moye J, June A, Martin LA, et al. Pain is prevalent and persisting in cancer survivors: differential factors across age groups. Journal of Geriatric Oncology 2014; 5: 190–6.CrossRefPubMedPubMedCentral
36.
go back to reference Desbiens NA, Wu AW, Broste SK, et al. Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations. For the SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Critical care medicine 1996; 24: 1953–61.CrossRefPubMed Desbiens NA, Wu AW, Broste SK, et al. Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations. For the SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Critical care medicine 1996; 24: 1953–61.CrossRefPubMed
37.
go back to reference Lillemoe KD, Cameron JL, Kaufman HS, et al. Chemical splanchnicectomy in patients with unresectable pancreatic cancer. A prospective randomized trial. Ann. Surg. 1993; 217: 447–55; discussion 456-7.CrossRefPubMedPubMedCentral Lillemoe KD, Cameron JL, Kaufman HS, et al. Chemical splanchnicectomy in patients with unresectable pancreatic cancer. A prospective randomized trial. Ann. Surg. 1993; 217: 447–55; discussion 456-7.CrossRefPubMedPubMedCentral
Metadata
Title
Prospective Evaluation of Associations between Cancer-Related Pain and Perineural Invasion in Patients with Resectable Pancreatic Adenocarcinoma
Authors
Rosalie A. Carr
Alexandra M. Roch
Xin Zhong
Eugene P. Ceppa
Nicholas J. Zyromski
Attila Nakeeb
C. Max Schmidt
Michael G. House
Publication date
01-10-2017
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 10/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-017-3513-z

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