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The value of the lymph node ratio and total number of lymph nodes examined for resected pancreatic signet ring cell carcinoma:a retrospective cohort study

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Journal of pancreatology 2022年第2期5卷 87-95页

作者： Chao Ren Feng Xue Yinying Wu Zheng Wang department of Hepatobiliary and Pancreatic Surgery The Affiliated Jinhua Hospital of Zhejiang University School of MedicineJinhuaChina department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi’an Jiaotong University Xi’anChina department of Medical Oncology of the First Affiliated Hospital of Xi’an Jiaotong University Xi’anChina

Background:Pancreatic signet ring cell carcinoma(SRCC)is an exceedingly rare histological subtype of pancreatic *** studies have focused on the trends of incidence and independent predictors of pancreatic *** objectives of the study were to analyze the prognostic value of the lymph node ratio(LNR)and to explore the minimal number of lymph nodes examined to accurately evaluate the N stage in resected pancreatic ***:We analyzed 120 patients diagnosed from January 1,1990,to December 31,2016,constituted the study cohort from the Surveillance,Epidemiology,and End Results(SEER)*** calculated the overall survival(OS)of these patients by using a Kaplan–Meier *** Kaplan–Meier analysis was used to analyze the influence of various factors on the prognosis of patients in the univariate *** multivariate Cox analysis were applied to find independent prognostic factors of patients with pancreatic ***-operating characteristic curve(ROC)analysis to investigate the discriminatory ability of the total number of lymph nodes examined(TNLE)relative to whether lymph node metastasis was ***:The median number of lymph nodes examined among 120 patients with resected pancreatic SRCC was 14(interquartile range:6.25–20.0).According to the univariate analysis of OS,age,grade,chemotherapy,LNR,and TNLE were significantly different(P<.05).We demonstrated the prognostic benefit of chemotherapy in resected pancreatic SRCC,whereas radiotherapy was not associated with improved *** multivariate survival analysis showed that LNR and grade were independent prognostic indicators after pancreatic SRCC resection for ***≥8 showed the highest discriminatory power for evaluating lymph node metastasis(Area under curve(AUC):0.656,95%confidence interval:0.564–0.741,Youden index:0.2533,sensitivity:78.67%,specificity:46.67%,P=.003).Conclusion:Our study indicated that the LNR was a valuable independent prognostic factor for resected

关键词： Independent factor Lymph node ratio Pancreatic signet ring cell carcinoma SEER database Total number of lymph nodes examined

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Can pathologists reliably establish ampulla of Vater carcinoma histologic subtype on H&E alone?Concordance of subtype and comparison to immunohistochemistry-established subtype

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Journal of pancreatology 2019年第4期2卷 152-157页

作者： Tanager Kevin S Li Yueying Alpert Lindsay Setia Namrata Weber Christopher Hart John Xiao Shu-Yuan department of Pathology The University of Chicago MedicineChicagoIL department of Pathology Wuhan University Zhongnan Hospital Wuhan University Center for Pathology and Molecular Diagnostics WuhanHubeiChina

Histologic subtyping of ampulla of Vater carcinoma(ampullary carcinoma,AC)may guide choice of adjuvant chemotherapy for advanced disease,as intestinal(INT)subtype may have a better treatment response and survival as compared to the pancreatobiliary(PB)and mixed(MIX)***,ambiguous morphologic features can result in inconsistent subtyping among *** immunohistochemistry(IHC)for cytokeratin(CK)7,CK20,CDX2,and the Mucin(MUC)family proteins had been used to aid in the *** is important to determine if accurate subtyping can be achieved based on hematoxylin and eosin(H&E)evaluation alone,or if IHC is *** this study,5 gastrointestinal pathologists evaluated 34 cases of AC for histologic subtype(PB,INT,or MIX)based on H&E stain *** studies(CK7,CK20,and CDX2)were used to determine a gold standard subtyping for comparison(strong CK7 with weak CK20 and CDX2=PB;strong CK20 or CDX2 and weak CK7=INT;strong CK7 and CK20 or CDX2=MIX).Interobserver concordance(kappa)was *** correctness of subtyping was calculated in relation to IHC-established subtype gold *** concordance for subtype was fair(kappa 0.31).Percent correctness for subtype against IHC-established subtype was 50%for a majority(3 or more)of *** all 11 cases with 4 or 5 pathologists being concordant,the subtype was also correctly *** addition,data on chemotherapy regimen and overall survival was gathered from the electronic medical *** who were assigned a subtype at time of diagnosis tended to receive gemcitabine for PB subtype,and FOLFOX-based therapy for INT subtype,with some cases diagnosed as"not-otherwise specified"typically also receiving *** data were limited by loss to *** conclusion,despite 11 cases with strong concordance and correctness,overall subtyping concordance was only fair,and a majority of the 5 pathologists correctly identified the subtype in only 50%of cases.T

关键词： Ampulla of Vater Immunohistochemistry Immunophenotyping Prognosis Subtype

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Acute venous thromboembolism in acute pancreatitis based on the severity:a retrospective cohort study

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Journal of pancreatology 2022年第1期5卷 10-17页

作者： Hassam Ali Swethaa Manickam Rahul Pamarthy Muhamad Fahd Farooq William Leland department of Internal Medicine East Carolina University/Vidant Medical CenterGreenvilleNC department of Gastroenterology East Carolina University/Vidant Medical CenterGreenvilleNCUSA

Objective: Acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with ***: We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate ***: The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P <.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < .001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4-5.3,P <.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04-1.1,P <.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4-7.4,P <.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6-14.1,P <.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74-0.81,P <.001).Conclusion: VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes;however, AP without necrosis does not increase upper and lower extremity VTE risk.

关键词： Acute pancreatitis Deep venous thrombosis Necrosis Severity Venous thromboembolism

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Metastatic well-differentiated pancreatic neuroendocrine tumors to the liver: a narrative review of systemic and surgical management

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Journal of pancreatology 2021年第2期4卷 82-89页

作者： Tanaz Vaghaiwalla Kelvin Memeh Chih-Yi Liao Xavier M.Keutgen department of Surgery Division of General SurgeryUniversity of Tennessee Graduate School of MedicineKnoxvilleTN b department of Surgery Division of Surgical OncologyEndocrine Surgery Research ProgramUniversity of Chicago Medicine department of Medicine Section of Hematology and OncologyUniversity of Chicago MedicineChicagoILUSA

Pancreatic neuroendocrine tumors(PNETs)are a rare group of neoplasms originating from the endocrine *** are classified as functional or non-functional *** are more often diagnosed at a higher stage with distant metastases or advanced locoregional *** majority of individuals with hepatic metastases will ultimately die of liver failure;therefore,the treatment of liver tumor burden is critical to providing a survival *** surgical resection remains the only chance of cure for disease confined to the pancreas or for locoregional disease,the treatment of advanced or metastatic PNETs is more complex and often requires a multimodal *** review focuses on treatment options for well and moderately differentiated PNETs with metastatic disease to the *** include surgery,liver-directed therapies including ablative and intra-arterial therapies,and systemic therapies such as somatostatin analogues,targeted therapies,chemotherapy,and peptide receptor radionuclide *** an individualized treatment strategy requires careful assessment of liver tumor burden and predicted biological *** surgical resection of hepatic metastases secondary to PNET primary tumors is associated with improved survival in multiple retrospective *** goals of treatment for metastatic disease include prolonging overall survival and progression free survival,improving quality of life,and control of symptoms.

关键词： Hepatic cytoreduction Metastatic disease Pancreatic neuroendocrine tumor Peptide receptor radionuclide therapy Review

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Prognostic factors for disease-free survival in patients with pancreatic ductal adenocarcinoma after surgery: a single center experience

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Journal of pancreatology 2019年第1期2卷 22-27页

作者： Xiaodong Tian Jisong Li Hongqiao Gao Yan Zhuang Yongsu Ma Yiran Chen Xuehai Xie Yinmo Yang department of General Surgery Peking University First HospitalBeijingChina

Objective: To evaluate the risk factors for the disease-free survival (DFS) of pancreatic ductal adenocarcinoma (PDAC) patients after surgery, and to validate the clinical applicability and prognostic stratification of the 8th edition American Joint Committee on Cancer (AJCC) staging system. Methods: A cohort of 185 patients with PDAC who underwent surgical resection in the General Surgery department of Peking University First Hospital from January 2010 to December 2017 was enrolled retrospectively. The clinicopathological characteristics and survival data were analyzed to find out risk factors correlated to DFS. The survival curves were calculated according to the 8th edition of AJCC staging system. Results:Among the 185 PDAC patients, 125 (67.6%) with pancreatic head carcinoma underwent pancreatoduodenectomy or total pancreatectomy, and 60 (32.4%) with tumors located in the pancreatic body and tail underwent distal pancreatectomy and splenectomy. R0 resection was achieved in 97 patients (52.4%), and the R1 and R2 resections rate was 44.9% and 2.7%, respectively. One hundred five patients (56.8%) received postoperative adjuvant chemotherapy. The median overall survival (OS) was 21 (95% confidence interval [CI] 17.7–24.3) months, and median DFS was 15 (95% CI 13.6–16.5) months. Univariate analysis showed that AJCC T and N staging, status of resection margin, grade of tumor differentiation, perineural invasion, intravascular cancer embolus, combined vascular resection, neutrophil-to-lymphocyte ratio (NLR)≥2, carcinoembryonic antigen ≥5ng/mL, carbohydrate antigen 19-9 (CA 19-9)≥400U/mL, and without postoperative adjuvant chemotherapy were correlated with shorter DFS. Furthermore, AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR≥2, CA 19-9≥400U/mL, and without postoperative adjuvant chemotherapy were independent risk factors for DFS. Both the DFS and OS curves were well separated by stage using the 8th sta

关键词： Disease-free survival Pancreatic ductal adenocarcinoma Prognostic factors TNM staging

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The impact of sarcopenia on patients undergoing treatment for pancreatic ductal adenocarcinoma

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Journal of pancreatology 2020年第2期3卷 59-71页

作者： Amundson Julia R. Williams Jelani K. Benjamin Andrew J. Witmer Hunter D.D. Roggin Kevin K. department of Surgery University of Chicago Medical CenterChicagoILUSA

Introduction:Pancreatic ductal adenocarcinoma(PDAC)is a deadly cancer that disproportionately affects geriatric *** therapy with surgery and chemotherapy is associated with longer survival than medical treatment or supportive *** selection of patients for surgical treatment,based on patient-specific factors such as sarcopenia,may help risk-stratify patients and improve *** paper aims to review the current literature on the impact of sarcopenia and sarcopenic obesity on patients undergoing treatment for ***:The impact of sarcopenia and sarcopenia obesity on perioperative and long-term outcomes after treatment for PDAC is *** has been associated with high-grade complications,longer length of hospital,and intensive care unit stays,more frequent discharge to skilled nursing facilities and decreased utilization of adjuvant therapy in patients treated with curative intent *** obesity has been associated with more complications,high-grade complications,and hematologic *** with sarcopenic obesity may have even lower overall survival than sarcopenic ***:The effect of a pre-treatment diagnosis of sarcopenia or sarcopenic obesity on outcomes for patients undergoing treatment for PDAC remains unknown,in part due to the heterogeneity of studies and *** programs including resistance exercise and nutritional supplementation have shown benefit in sarcopenic ***:PDAC remains a deadly disease and patient-specific factors such as sarcopenia and sarcopenic obesity identified at the time of cancer diagnosis offer potential as risk stratification measures and points of ***,a paucity of standardized measurement tools,definitions,and prehabilitation regimens limits the clinical implementation of such knowledge.

关键词： Frailty Pancreatic ductal adenocarcinoma Sarcopenia

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Predictive molecular markers in the era of immunotherapy

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Journal of pancreatology 2020年第3期3卷 132-138页

作者： Teddy S.Nagaria Hua Wang Huamin Wang department of Anatomical Pathology The University of Texas MD Anderson Cancer CenterHoustonTXUSA department of Gastrointestinal Medical Oncology The University of Texas MD Anderson Cancer CenterHoustonTXUSA department of Translational Molecular Pathology The University of Texas MD Anderson Cancer CenterHoustonTXUSA

Recent development in anticancer therapeutics has been centered on immune checkpoint inhibitors(ICIs).Despite early success of ICIs in several cancer types,majority of cancer patients do not respond to ICI ***,predictive biomarkers are urgently needed to select patients who would likely benefit from ICI *** immunohistochemical(IHC)assay for programmed cell death ligand 1(PD-L1)and microsatellite instability(MSI)testing are the only Food and Drug Administration-approved predictive biomarkers for ICI *** mutation burden(TMB)and tumor infiltrating lymphocytes(TILs)are emerging markers,which may prove to be useful predictive markers for *** guidelines for MSI testing have been well ***,rigorous quality controls and systemic standardization for PD-L1 IHC testing and analysis of TMB and TILs,such as sample selection,tissue fixation,assay/platform selection,scoring methods,and clinically meaningful cutoff values *** needed to improve their clinical utility as predictive biomarkers for ICI *** have suggested that the results of PD-L1 expression in tumor cells from various PD-L1 IHC assays are concordant and may be ***,the variations and poor interobserver concordance of PDL1 expression in immune cells is a major issue to be addressed for the interchangeability of different PD-L1 IHC assays,especially for carcinomas of the gastrointestinal *** of new predictive biomarkers and better understanding the difference in tumor immune microenvironments between ICI-sensitive and ICI-resistant tumors will help to develop more effective strategies for immunotherapy.

关键词： CTLA-4 Immune checkpoint inhibitors Microsatellite instability PD-1 PD-L1 Tumor infiltrating lymphocytes Tumor mutation burden

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Update on mucinous cystic neoplasm of the pancreas:a narrative review

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Journal of pancreatology 2021年第3期4卷 115-121页

作者： Wen Xie Huaiyu Liang Yan Guo Shu-Yuan Xiao department of Pathology Zhongnan Hospital of Wuhan UniversityWuhan University Center for Pathology and Molecular DiagnosticsWuhanHubei Province department of Pathology Ruijin HospitalShanghai Jiao Tong University School of Medicine Histopathology Diagnostic Center ShanghaiChina department of Pathology University of Chicago MedicineChicago 60637ILUSA

Mucinous cystic neoplasm(MCN)of the pancreas is an exocrine cystic tumor with a potential of harboring *** latest World Health Organization classification of tumors of digestive system designates malignant MCN as MCN with associated invasive carcinoma(MCN-AIC).Since its separation from other pancreatic cystic tumors in 1978,much progress has been made in our understanding of MCN in epidemiology,clinical and pathological features,biological behavior,as well as prognostic *** review aims to summarize the current knowledge of MCN and MCN-AIC.

关键词： Invasive carcinoma Molecular genetics Mucinous cystic neoplasm Ovarian-type stroma Prognosis

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An unrecognized undifferentiated tumor of the pancreas:a case report

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Journal of pancreatology 2023年第4期6卷 225-227页

作者： Chaoyu Pang Zhiyao Fan Peng Su Hanxiang Zhan Division of Pancreatic Surgery Department of General SurgeryQilu HospitalShandong UniversityJinan 250012China department of Pathology Qilu HospitalShandong UniversityJinan 250012China

SMARCA4-deficient tumors are gaining attention,and this type of tumor is highly malignant with a poor *** frequency of SMARCA4 deletion varies in different ***,it has never been identified in the pancreas.A 67-year-old woman pre-sented with upper abdominal pain lasting for half a *** tomography indicated a space-occupying lesion in the head of the pancreas,considered a malignant *** Endoscopic ultrasound fine-needle aspiration was performed and report-ed as SMARCA4-deficient undifferentiated pancreatic *** patient received no treatment and survived only two and a half months from diagnosis to *** are the first to report SMARCA4-deficient pancreatic undifferentiated tumor in which this new tumor entity presents with poorer overall *** also summarized the advances of SMARCA4 in oncology and treatment.

关键词： Immune checkpoint inhibitors Pancreatic undifferentiated tumor SMARCA4-deficient SWI/SNF

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Management of pancreatic fluid collections in patients with acute pancreatitis

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Journal of pancreatology 2019年第3期2卷 82-90页

作者： Mahapatra Soumya J. Garg Pramod K. department of Gastroenterology All India Institute of Medical SciencesNew DelhiIndia

Acute pancreatitis is associated with development of pancreatic fluid collections(PFCs).Acute PFCs that develop in interstitial edematous pancreatitis mostly resolve but some may persist and evolve into *** necrotic collections occurring in acute necrotizing pancreatitis generally persist and evolve into walled-off necrosis(WON)after 3 to 4 *** acute fluid collections do not require drainage unless they are large and cause compression of adjacent organs,contribute to increase in intraabdominal pressure or become *** infected collections can be managed with antibiotics and percutaneous drainage but may require necrosectomy either by minimally invasive surgical or endoscopic methods such as video-assisted retroperitoneal debridement and percutaneous endoscopic *** sterile collections,that is,pseudocyst and WON with a defined wall are best treated by internal transmural drainage which can be achieved either by per-oral endoscopic or surgical,preferably laparoscopic,*** late,infected PFCs are increasingly being treated with an endoscopic step-up approach that has been shown to be better than minimally invasive surgical step-up approach in terms of lesser *** of lumen apposing metal stents during endoscopic drainage has emerged as an attractive option that facilitates necrosectomy in infected WON.

关键词： Acute pancreatitis Infected pancreatic necrosis Necrosectomy Pancreatic fluid collections Walled-off necrosis

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