Prognostic Significance of Extrapancreatic Invasion in Pancreatic Cancer: Excellent Outcomes in Patients With Disease Confined Within the Pancreas.
Extrapancreatic invasion (EPI) is a well-known adverse prognostic factor in pancreatic cancer; however, whether the absence of EPI defines a distinct clinical entity remains unclear. This study aimed to clarify the clinicopathological features and prognosis of pancreatic ductal adenocarcinoma (PDAC) confined within the pancreas.
A total of 199 patients who underwent curative-intent pancreatectomy for PDAC between 2012 and 2022 were retrospectively analyzed. Patients were classified into EPI-negative (n=19) and EPI-positive (n=180) groups. Clinicopathological characteristics, recurrence-free survival (RFS), and overall survival (OS) were compared between the two groups.
EPI-positive tumors were significantly associated with higher CA19-9 levels, larger tumor size, lymph node metastasis, and lymphovascular/perineural invasion. None of the EPI-negative patients experienced recurrence within 3 years or disease-specific death within 5 years. Multivariate analysis identified the absence of EPI as an independent favorable prognostic factor for both RFS and OS.
PDAC confined within the pancreas, without EPI, represents a biologically distinct subset with remarkably favorable outcomes. Assessing EPI status may aid in tailoring perioperative treatment strategies and preventing overtreatment in selected patients.
A total of 199 patients who underwent curative-intent pancreatectomy for PDAC between 2012 and 2022 were retrospectively analyzed. Patients were classified into EPI-negative (n=19) and EPI-positive (n=180) groups. Clinicopathological characteristics, recurrence-free survival (RFS), and overall survival (OS) were compared between the two groups.
EPI-positive tumors were significantly associated with higher CA19-9 levels, larger tumor size, lymph node metastasis, and lymphovascular/perineural invasion. None of the EPI-negative patients experienced recurrence within 3 years or disease-specific death within 5 years. Multivariate analysis identified the absence of EPI as an independent favorable prognostic factor for both RFS and OS.
PDAC confined within the pancreas, without EPI, represents a biologically distinct subset with remarkably favorable outcomes. Assessing EPI status may aid in tailoring perioperative treatment strategies and preventing overtreatment in selected patients.
Authors
Saito Saito, Amemiya Amemiya, Izumo Izumo, Oka Oka, Maruyama Maruyama, Takiguchi Takiguchi, Shoda Shoda, Shiraishi Shiraishi, Furuya Furuya, Kawaguchi Kawaguchi, Kawaida Kawaida, Ichikawa Ichikawa
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