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Reticular pattern around superior mesenteric artery in computed tomography imaging predicting poor prognosis of pancreatic head cancer
Author(s) -
Kato Tomotaka,
Ban Daisuke,
Tateishi Ukihide,
Ogura Toshiro,
Ogawa Kosuke,
Ono Hiroaki,
Mitsunori Yusuke,
Kudo Atsushi,
Tanaka Shinji,
Tanabe Minoru
Publication year - 2020
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.700
Subject(s) - medicine , reticular connective tissue , sma* , superior mesenteric artery , pancreaticoduodenectomy , pancreatic cancer , radiology , pathology , cancer , pancreas , mathematics , combinatorics
Background Some patients with pancreatic ductal adenocarcinoma (PDAC) demonstrate a reticular pattern around the superior mesenteric artery (SMA) in computed tomography scans. This study aimed to clarify the clinical significance of the reticular pattern in pancreatic head cancer. Methods A total of 91 patients with pancreatic head cancer, who underwent upfront pancreaticoduodenectomy between 2004 and 2017, were included. Patients without reticular pattern (Non‐group, n = 39); with reticular pattern around SMA (Ret‐group, n = 39); and with soft tissue contact (Soft‐group, n = 13) were compared. Results Median overall survival (OS) of patients in the Ret‐group was significantly worse than that in the Non‐group (21.3 vs. 57.0 months; P < 0.001) and equivalent to that in the Soft‐group. In the multivariate analysis, reticular pattern and high CA19‐9 levels were identified as independent predictors of OS. Microscopically, only fibrotic thickenings were identified corresponding to the reticular pattern areas, and no difference in the frequency of early local recurrence was noted between the Non and Ret‐groups. Lymphovascular invasion was significantly different between the two groups; furthermore, early distant recurrence was more frequent in the Ret‐group. Conclusions The reticular pattern around SMA is an important prognostic factor related to frequent distant recurrence in patients with pancreatic cancer.