Morphologic Characterization of Pancreatic Ductal Adenocarcinoma following Post-neoadjuvant Pancreatectomy and Clinical value of Intratumor Heterogeneity.

IF 7.5 1区医学 Q1 SURGERY

Annals of surgery Pub Date : 2024-10-15 DOI:10.1097/sla.0000000000006565

Gabriella Lionetto,Paola Mattiolo,Calogero Ciulla,Giulia Savegnago,Fabio Casciani,Matteo De Pastena,Salvatore Paiella,Antonio Pea,Alessandro Esposito,Anna Crovetto,Massimo Donadelli,Carlotta Franzina,Matteo Fassan,Aldo Scarpa,Roberto Salvia,Giuseppe Malleo,Claudio Luchini

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引用次数: 0

Abstract

OBJECTIVE To evaluate the morphologic landscape of pancreatic ductal adenocarcinoma (PDAC), intratumor spatial heterogeneity, and the resulting clinical impact following post-neoadjuvant pancreatectomy. SUMMARY BACKGROUND DATA The clinical value of PDAC morphologic subtypes and intratumor spatial heterogeneity post-treatment remains an open issue. MATERIALS AND METHODS The study cohort included patients who underwent post-neoadjuvant pancreatectomy for PDAC at the University of Verona Hospital Trust between 2013 and 2019. All hematoxylin and eosin-stained slides were reviewed to assess PDAC histomorphology and intratumor heterogeneity. The relationship with other clinicopathological variables, overall survival (OS), and recurrence-free (RFS) survival was evaluated using standard statistics. RESULTS The study cohort included 400 patients. Histological revision identified ten different morphologic subtypes. Gland-forming PDAC with a conventional pattern was the most frequently identified subtype (41.8%). Overall, 247 tumors (61.7%) showed only one histological pattern and were classified as homogeneous, whereas 153 (38.3%) showed different morphologies and were classified as heterogeneous tumors. The median post-resection survival was 30.1 months (95%CI 26.6-33.5). There was a substantial survival variability according to the morphologic subtype, ranging from 19.1 months in the gyriform subtype to 47.0 months in the papillary subtype. Tumors with a heterogeneous morphology displayed a higher rate of nodal metastases, worse tumor regression metrics, and worse oncologic outcomes relative to spatially homogeneous tumors. DISCUSSION This paper provided a morphological taxonomy of residual tumors following post-neoadjuvant pancreatectomy for PDAC. The morphologic subtype and intratumor spatial heterogeneity have relevant prognostic implications and could be included in the pathology report to complement regression metrics.

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胰腺新辅助切除术后胰腺导管腺癌的形态学特征及瘤内异质性的临床价值

目的评估新辅助治疗后胰腺切除术后胰腺导管腺癌（PDAC）的形态特征、肿瘤内空间异质性以及由此产生的临床影响。摘要背景资料PDAC形态亚型和治疗后肿瘤内空间异质性的临床价值仍是一个悬而未决的问题。材料与方法研究队列包括2013年至2019年期间在维罗纳大学医院信托基金接受新辅助治疗后胰腺切除术治疗PDAC的患者。对所有苏木精和伊红染色的切片进行了审查，以评估 PDAC 组织形态学和肿瘤内异质性。使用标准统计学方法评估了与其他临床病理变量、总生存期（OS）和无复发生存期（RFS）之间的关系。组织学修订确定了十种不同的形态亚型。具有传统模式的腺形成 PDAC 是最常见的亚型（41.8%）。总体而言，247 例肿瘤（61.7%）只显示一种组织学形态，被归类为同种肿瘤，而 153 例肿瘤（38.3%）显示不同形态，被归类为异种肿瘤。切除后的中位生存期为 30.1 个月（95%CI 26.6-33.5）。形态亚型的生存期差异很大，从回形亚型的19.1个月到乳头亚型的47.0个月不等。与空间均一的肿瘤相比，形态异型的肿瘤显示出更高的结节转移率、更差的肿瘤消退指标和更差的肿瘤学预后。形态亚型和瘤内空间异质性对预后有相关影响，可纳入病理报告以补充回归指标。

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.