Abstract
Pancreatic ductal adenocarcinoma is an aggressive tumor with short survival. In this study we aimed to investigate the effect of well-known prognostic parameters on survival in these tumors. A total of 56 pancreatic ductal adenocarcinoma cases diagnosed between 2005 and 2014 were included in the study. Survival data were obtained and histopathological parameters were re-evaluated in each patient. Tumor size (p=0.029), mitotic count (p=0.030), lymph node metastasis (p=0.003), metastatic lymph node ratio (p < 0.001) and ampullary invasion (p=0.044) had a statistically significant relationship with survival. However, there was no relationship between survival and tumor grade, lymphovascular and perineural invasion, and peripancreatic soft tissue invasion. Our results showed that existent 2010 WHO pancreatic ductal adenocarcinoma grading parameters excluding mitotic count are subjective and not applicable. Considering that almost all of the tumors in our series were larger than 2 cm, we think that the 2 cm cut-off in tumor size is insufficient to make the tumor stage pT2. Peripancreatic soft tissue invasion, which is a common finding in pancreatic ductal adenocarcinoma, should also not be assessed like adjacent tissue invasion and make the tumor reach pT3 stage independent of tumor size. It is clear that the existent WHO tumor grading and pT staging parameters need to be revised and the mitotic count, which correlates with survival, should be presented in pathology reports.
Highlights
Pancreatic ductal adenocarcinoma (PDAC), representing the majority (80-90%) of pancreatic neoplasia, is the fourth leading cause of cancer-related deaths
There was no relationship between survival and tumor grade, lymphovascular and perineural invasion, and peripancreatic soft tissue invasion
Our results showed that existent 2010 WHO pancreatic ductal adenocarcinoma grading parameters excluding mitotic count are subjective and not applicable
Summary
Pancreatic ductal adenocarcinoma (PDAC), representing the majority (80-90%) of pancreatic neoplasia, is the fourth leading cause of cancer-related deaths. These tumors tend to present with non-specific symptoms and generally in advanced stages. High recurrence and metastatic capacity support the aggressiveness and high mortality rates in these tumors [1, 2]. The most important prognostic parameter is total resection of the tumor. Only 10-20% of the patients have surgically resectable tumors at the time of diagnosis [3, 4]. Even in patients who undergo total resection, the overall survival only increases from 3-5 months to 10-20 months [3, 5]
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