Clinical Features and Prognostic Impact of Pancreatic Ductal Adenocarcinoma without Dilatation of the Main Pancreatic Duct: A Single-Center Retrospective Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Evaluations
2.3. Imaging and Pathological Diagnosis
2.3.1. Imaging Diagnosis
2.3.2. Pathological Diagnosis
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Reasons for Medical Examination
3.3. Imaging Findings
3.4. Pathological Diagnosis
3.5. Clinical Stage and Resectability Classification
3.5.1. Prognosis
3.5.2. Factors Affecting PDAC Prognosis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Dilatation Group (n = 215) | Non-Dilatation Group (n = 66) | p-Value | |
---|---|---|---|
Sex, n (male/female) | 124/91 | 39/27 | 0.82 |
Age, mean ± SD (range) | 74 ± 7 (43–97) | 74 ± 5 (45–94) | 0.9 |
Tumor size, mm (range) | 30.1 (17–43) | 33.7 (18–48) | 0.75 |
Location | |||
head/body/tail, n (%) | 141 (66)/59 (27)/15 (7.0) | 22 (33)/4 (6)/40 (61) | <0.001 |
Risk factors, n (%) | |||
DM | 50 (23) | 19 (29) | 0.62 |
Tobacco use | 53 (25) | 17(26) | 0.87 |
IPMN | 36 (17) | 13 (20) | 0.27 |
Chronic pancreatitis | 9 (4.2) | 1 (1.5) | 0.13 |
Heavy alcohol consumption | 41 (19) | 12 (18) | 0.85 |
Obesity (>BMI 30 kg/m2) | 5 (2.3) | 2 (3.0) | 0.92 |
Family history of pancreatic cancer | 7 (3.2) | 2 (3.0) | 1 |
Examination Opportunities | Dilatation Group (n = 215) (%) | Non-Dilatation Group (n = 66) (%) | p-Value |
---|---|---|---|
Symptoms | 130/215 (60) | 40/66 (61) | 0.77 |
Abdominal pain | 54/130 (42) | 16/40 (40) | 1 |
Back pain | 10/130 (7.7) | 2/40 (5.0) | 1 |
Nausea | 9/130 (6.9) | 2/40 (5.0) | 1 |
Diarrhea | 3/130 (2.3) | 2/40 (5.0) | 1 |
Jaundice | 52/130 (40) | 6/40 (15) | 0.014 |
Weight loss | 1/130 (0.77) | 4/40 (10) | 0.008 |
Other | 24/130 (18) | 10/40 (25) | 0.052 |
Abnormalities identified on medical check-up | 14/215 (6.5) | 8/66 (12) | 1 |
Abnormal findings on US | 12/14 (86) | 3/8 (38) | 0.055 |
Elevated tumor marker levels | 1/14 (7.1) | 4/8 (50) | 0.11 |
Others | 1/14 (7.1) | 1/5 (20) | 0.4 |
Abnormalities identified during screening for other diseases | 58/215 (27) | 15/66 (23) | 0.74 |
Abnormal imaging findings | 54/58 (92) | 15/15 (100) | 1 |
Plain CT | 9/54 (17) | 7/15 (47) | 0.088 |
CECT | 26/54 (48) | 7/15 (47) | 0.47 |
US | 18/54 (33) | 0/15 (0) | 0.25 |
MRI | 0/54 (0) | 0/15 (0) | 1 |
EUS | 1/54 (1.9) | 0/15 (0) | 0.055 |
PET–CT | 0/54 (0) | 1/15 (6.7) | 0.21 |
Elevated pancreatic enzymes | 2/58 (3.4) | 0/15 (0) | 1 |
Elevated tumor marker levels | 2/58 (3.4) | 1/15 (6.7) | 0.46 |
Abnormalities during follow-up of pancreatic diseases | 10/215 (4.7) | 3/66 (4.5) | 0.75 |
Other | 1/215 (0.47) | 0/66 (0) | 1 |
Dilatation Group (n = 215) (%) | Non-Dilatation Group (n = 66) (%) | p-Value | |
---|---|---|---|
Imaging performed, US/CT/MRI/EUS | 151/207/133/179 | 48/54/37/49 | |
Detection of pancreatic tumors | |||
US | 129/151 (85) | 20/48 (42) | <0.001 |
CECT | 195/207 (94) | 50/54 (93) | 0.75 |
MRI T1 | 93/133 (70) | 24/37 (65) | 0.85 |
MRI T2 | 78/133 (59) | 18/37 (49) | 0.58 |
DW-MRI | 119/133 (89) | 32/37 (86) | 0.8 |
EUS | 178/179 (99) | 48/49 (98) | 0.38 |
Indirect imaging findings | |||
MPD dilatation | |||
US | 106/151 (70) | ||
CECT | 197/207 (95) | ||
MRI (MRCP) | 122/133 (92) | ||
EUS | 161/179 (90) | ||
MPD stenosis | |||
US | 89/151 (59) | 0/48 (0) | <0.001 |
CECT | 194/207 (94) | 0/54 (0) | <0.001 |
MRI (MRCP) | 118/133 (89) | 1/37 (2.7) | <0.001 |
EUS | 156/179 (87) | 2/49 (4.1) | <0.001 |
Dilatation Group (n = 215) (%) | Non-Dilatation Group (n = 66) (%) | p-Value | ||
---|---|---|---|---|
ERCP | 131/215 (61) | 14/66 (21) | <0.001 | |
Biopsy of CBD stenosis | 30/61 (49) | 4/6 (67) | 0.67 | |
Brushing cytology of CBD stenosis | 30/79 (38) | 3/11 (27) | 0.74 | |
ENBD | 20/73 (27) | 0/6 (0) | 0.33 | |
Single aspiration of pancreatic juice | 15/37 (41) | 0/1 (0) | 1 | |
Brushing cytology of MPD stenosis | 27/47 (57) | 1/1 (100) | 1 | |
SPACE | 18/32 (56) | 0/2 (0) | 0.21 | |
Confirmation of malignancy | 82/131 (63) | 8/14 (57) | 0.78 | |
EUS-FNA | 154/215 (72) | 45/66 (68) | 0.36 | |
Biopsy | 142/154 (92) | 44/45 (98) | 0.3 | |
Gastrointestinal biopsy | 20/21 (95) | 7/7 (100) | 1 | |
Liver tumor biopsy | 3/4 (75) | 4/4 (100) | 1 | |
Cytology of ascites | 3/6 (50) | 5/7 (71) | 0.59 |
(A) | |||
---|---|---|---|
Clinical Stage | Dilatation Group (n = 215) (%) | Non-Dilatation Group (n = 66) (%) | p-Value |
0 | 3 (1.4) | 1 (1.5) | 1 |
IA | 5 (2.3) | 2 (3.0) | 0.67 |
IB | 8 (3.7) | 1 (1.5) | 0.69 |
IIA | 67 (31) | 10 (15) | <0.001 |
IIB | 12 (5.6) | 2 (3.0) | 0.74 |
III | 41 (19) | 8 (12) | 0.33 |
IV | 79 (37) | 42 (64) | <0.001 |
(B) | |||
Resectability Classification | Dilatation Group (n = 215) (%) | Non-Dilatation Group (n = 66) (%) | p-Value |
R | 62 (29) | 14 (21) | 0.16 |
BR-PV | 34 (16) | 1 (1.5) | 0.004 |
BR-A | 5 (2.3) | 2 (3.0) | 1 |
UR-LA | 35 (16) | 7 (11) | 0.68 |
UR-M | 79 (37) | 42 (64) | <0.001 |
Univariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|
Hr (95% Ci) | p-Value | Hr (95% Ci) | p-Value | |
Tumor location | ||||
Head/Body | 1 | 1 | ||
Tail | 1.59 (1.11–2.25) | 0.011 | 1.28 (0.78–2.09) | 0.331 |
Jaundice | ||||
No | 1 | |||
Yes | 1.15 (0.75–1.76) | 0.515 | ||
Weight loss | ||||
No | 1 | |||
Yes | 0.38 (0.05–2.57) | 0.306 | ||
Clinical stage | ||||
0-I | 1 | 1 | ||
II–III | 1.60 (0.69–3.71) | 0.268 | 1.28 (0.51–3.18) | 0.599 |
IV | 2.05 (1.42–3.00) | 0.016 | 2.83 (1.00–8.00) | 0.049 |
Resectability classification | ||||
R | 1 | 1 | ||
BR-PV or BR-A | 1.54 (0.89–2.66) | 0.124 | 1.58 (0.86–2.89) | 0.138 |
UR-LA or UR-M | 2.19 (1.48–3.22) | <0.001 | 1.25 (0.65–2.42) | 0.503 |
Treatment | ||||
Surgery | 1 | 1 | ||
Chemotherapy or CRT | 1.58 (0.97–2.58) | 0.068 | 0.74 (0.41–1.34) | 0.318 |
Best supportive care | 4.20 (2.63–6.70) | <0.001 | 2.92 (1.73–4.93) | <0.001 |
Presence of MPD dilatation (≥3 mm) | ||||
Yes | 1 | 1 | ||
No | 0.51 (0.34–0.78) | 0.001 | 0.77 (0.53–1.14) | 0.753 |
Type | I | II | III | IV | V |
---|---|---|---|---|---|
n | 1 | 10 | 11 | 4 | 40 |
Bile duct obstruction | 0 | 4 | 8 | 1 | 0 |
Duodenal invasion | 0 | 4 | 4 | 0 | 0 |
Duodenal obstruction | 0 | 4 | 1 | 0 | 0 |
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Takayanagi, T.; Sekino, Y.; Kasuga, N.; Ishii, K.; Nagase, H.; Nakajima, A. Clinical Features and Prognostic Impact of Pancreatic Ductal Adenocarcinoma without Dilatation of the Main Pancreatic Duct: A Single-Center Retrospective Analysis. Diagnostics 2023, 13, 963. https://doi.org/10.3390/diagnostics13050963
Takayanagi T, Sekino Y, Kasuga N, Ishii K, Nagase H, Nakajima A. Clinical Features and Prognostic Impact of Pancreatic Ductal Adenocarcinoma without Dilatation of the Main Pancreatic Duct: A Single-Center Retrospective Analysis. Diagnostics. 2023; 13(5):963. https://doi.org/10.3390/diagnostics13050963
Chicago/Turabian StyleTakayanagi, Takuya, Yusuke Sekino, Noriki Kasuga, Ken Ishii, Hajime Nagase, and Atsushi Nakajima. 2023. "Clinical Features and Prognostic Impact of Pancreatic Ductal Adenocarcinoma without Dilatation of the Main Pancreatic Duct: A Single-Center Retrospective Analysis" Diagnostics 13, no. 5: 963. https://doi.org/10.3390/diagnostics13050963