Adequate sampling is essential to an accurate pathologic evaluation of pancreatectomy specimens resected for pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy (NAT). However, limited data are available for the association between the sampling and survival in these patients. We examined the association of the entire submission of the tumor (ESOT) and the entire submission of the pancreas (ESOP) with disease-free survival (DFS) and overall survival (OS), as well as their correlations with clinicopathologic features, for 627 patients with PDAC who received NAT and pancreaticoduodenectomy. We demonstrated that both ESOT and ESOP were associated with lower ypT, less frequent perineural invasion, and better tumor response (p< 0.05). ESOP was also associated with a smaller tumor size (p< 0.001), more lymph nodes (p< 0.001), a lower ypN stage (p< 0.001), better differentiation (p= 0.02), and less frequent lymphovascular invasion (p= 0.009). However, since ESOP and ESOT were primarily conducted for cases with no grossly identifiable tumor or minimal residual carcinoma in initial sections, potential bias cannot be excluded. Both ESOT and ESOP were associated with less frequent recurrence/metastasis and better DFS and OS (p< 0.05) in the overall study population. ESOP was associated with better DFS and better OS in patients with ypT0/ypT1 or ypN0 tumors and better OS in patients with complete or near-complete response (p< 0.05). ESOT was associated with better OS in patients with ypT0/ypT1 or ypN0 tumors (p< 0.05). Both ESOT and ESOP were independent prognostic factors for OS according to multivariate survival analyses. Therefore, accurate pathologic evaluation using ESOP and ESOT is associated with the prognosis in PDAC patients with complete or near-complete pathologic response and ypT0/ypT1 tumor after NAT.
充分的标本取样对于新辅助治疗后胰腺导管腺癌切除术标本的准确病理评估至关重要。然而，关于取样方式与患者生存率相关性的研究数据有限。本研究对627例接受新辅助治疗及胰十二指肠切除术的胰腺导管腺癌患者进行分析，探讨肿瘤全标本提交和胰腺全标本提交与无病生存期、总生存期的关联性及其与临床病理特征的相关性。研究发现，两种取样方式均与较低的ypT分期、较少神经侵犯及更好的肿瘤反应显著相关（p<0.05）。胰腺全标本提交还与较小肿瘤体积（p<0.001）、更多淋巴结检出（p<0.001）、较低ypN分期（p<0.001）、更好分化程度（p=0.02）及较少淋巴血管侵犯（p=0.009）相关。但需注意，两种取样方式主要应用于大体未见明确肿瘤或初始切片仅见微小癌残留的病例，可能存在选择偏倚。在总体研究人群中，两种取样方式均与较低复发/转移率及更好的无病生存期、总生存期显著相关（p<0.05）。分层分析显示：对于ypT0/ypT1或ypN0肿瘤患者，胰腺全标本提交与更好的无病生存期和总生存期相关；对于达到完全或接近完全病理缓解的患者，胰腺全标本提交与更好的总生存期相关（p<0.05）；而肿瘤全标本提交在ypT0/ypT1或ypN0肿瘤患者中与更好的总生存期相关（p<0.05）。多因素生存分析证实两种取样方式均为总生存期的独立预后因素。因此，采用胰腺全标本提交和肿瘤全标本提交进行精准病理评估，与新辅助治疗后达到完全/接近完全病理缓解及ypT0/ypT1分期胰腺导管腺癌患者的预后改善密切相关。
肿瘤(癌症)患者之家