Influence of Perineural Invasion on Survival and Recurrence in Patients with Resected Pancreatic Cancer

Jun-Feng Zhang,Yan-Miao Huo,Rong Hua,Wei Liu,Yong-Wei Sun,De-Jun Liu,Jiao Li

doi:10.7314/apjcp.2013.14.9.5133

Jun-Feng Zhang, Yan-Miao Huo + Show 5 more

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https://doi.org/10.7314/apjcp.2013.14.9.5133

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Abstract

Perineural invasion (PNI) has been reported as one of the sources of locoregional recurrence in resected pancreatic cancer (PC). However the impact of PNI in resected pancreatic cancer remains controversial. The purpose of this study was to determine the association between PNI status and clinical outcomes. Publications were identified which assessed prognostic significance of PNI status in resected pancreatic cancer up to February 2013. A meta-analysis was performed to clarify the association between PNI status and clinical outcomes. A total of 21 studies met the inclusion criteria, covering 4,459 cases. Analysis of these data showed that intrapancreatic PNI was correlated with reduced overall survival only in resected pancreatic ductal adenocarcinoma (PDAC) patients (HR=1.982, 95%CI: 1.526-2.574, p=0.000). Extrapancreatic PNI was correlated with reduced overall survival in all resected pancreatic cancer patients (HR=1.748, 95%CI: 1.372- 2.228, p=0.000). Moreover, intrapancreatic PNI status may be associated with tumor recurrence in all resected pancreatic cancer patients (HR=2.714, 95%CI: 1.885-3.906, p=0.000). PNI was an independent and poor prognostic factor in resected PDAC patients. Moreover, intrapancreatic PNI status may be associated with tumor recurrence.

Highlights

Pancreatic cancer is a malignancy with a very poor prognosis
We considered that different pathological types result in a significant heterogeneity in the meta-analysis of intrapancreatic Perineural invasion (PNI) on OS
Compare with pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer, several studies had proved that other pathological types of pancreatic cancer have better prognosis, such as neuroendocrine carcinoma (Winter et al, 2006), intraductal papillary mucinous neoplasm(IPMN) with invasive cancer (Waters et al, 2011), adenosquamous carcinoma (Boyd et al, 2012)

Summary

Introduction

Pancreatic cancer is a malignancy with a very poor prognosis. Patients with resectable pancreatic cancer comprise a small subgroup of the overall population from around 15 to 20% (Mancuso et al, 2006). A systematic review (Garcea et al, 2008) analysed studies detailing outcomes following resection for PDAC from 1980 to 2008 and showed that meta-analysis of yearly survival data for PNI did not achieve statistical significance. In order to address the controversial issues, we performed a meta-analysis to determine the association between PNI status and clinical outcomes. A meta-analysis was performed to clarify the association between PNI status and clinical outcomes. Results: A total of 21 studies met the inclusion criteria, covering 4,459 cases Analysis of these data showed that intrapancreatic PNI was correlated with reduced overall survival only in resected pancreatic ductal adenocarcinoma (PDAC) patients (HR=1.982, 95%CI: 1.526-2.574, p=0.000). Intrapancreatic PNI status may be associated with tumor recurrence in all resected pancreatic cancer patients (HR=2.714, 95%CI: 1.885-3.906, p=0.000).

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