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Microvascular invasion is a major prognostic factor after pancreatico‐duodenectomy for adenocarcinoma
Author(s) -
Panaro Fabrizio,
Kellil Tarek,
Vendrell Julie,
Sega Valentina,
Souche Regis,
Piardi Tullio,
Leon Piera,
Cassinotto Christophe,
Assenat Eric,
Rosso Edoardo,
Navarro Francis
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25580
Subject(s) - medicine , gastroenterology , adenocarcinoma , multivariate analysis , cohort , lymph node , univariate analysis , oncology , survival analysis , pancreatic cancer , pathological , cancer
Background Microvascular invasion (MVI) has been proved to be poor prognostic factor in many cancers. To date, only one study published highlights the relationship between this factor and the natural history of pancreatic cancer. The aim of this study was to assess the impact of MVI, on disease‐free survival (DFS) and overall survival (OS), after pancreatico‐duodenectomy (PD) for pancreatic head adenocarcinoma. Secondarily, we aim to demonstrate that MVI is the most important factor to predict OS after surgery compared with resection margin (RM) and lymph node (LN) status. Materials and Methods Between January 2015 and December 2017, 158 PD were performed in two hepato‐bilio‐pancreatic (HBP) centers. Among these, only 79 patients fulfilled the inclusion criteria of the study. Clinical‐pathological data and outcomes were retrospectively analyzed from a prospectively maintained database. Results Of the 79 patients in the cohort, MVI was identified in 35 (44.3%). In univariate analysis, MVI ( P = .012 and P < .0001), RM ( P = .023 and P = .021), and LN status ( P < .0001 and P = .0001) were significantly associated with DFS and OS. A less than 1 mm margin clearance did not influence relapse ( P = .72) or long‐term survival ( P = .48). LN ratio > 0.226 had a negative impact on OS ( P = .044). In multivariate analysis, MVI and RM persisted as independent prognostic factors of DFS ( P = .0075 and P = .0098, respectively) and OS ( P < .0001 and P = .0194, respectively). Using the likelihood ratio test, MVI was identified as the best fit to predict OS after PD for ductal adenocarcinomas compared with the margin status model (R0 vs R1) ( P = .0014). Conclusion The MVI represents another major prognostic factor determining long‐term outcomes.