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Pancreatic fibrosis, acinar atrophy and chronic inflammation in surgical specimens associated with survival in patients with resectable pancreatic ductal adenocarcinoma

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Pancreatic ductal adenocarcinoma (PDAC), one of the most lethal malignancies, is increasing in incidence. However, the stromal reaction pathophysiology and its role in PDAC development remain unknown. We, therefore, investigated the potential role of histological chronic pancreatitis findings and chronic inflammation on surgical PDAC specimens and disease-specific survival (DSS). | Korpela et al. BMC Cancer 2022 22 23 https doi.org 10.1186 s12885-021-09080-0 RESEARCH Open Access Pancreatic fibrosis acinar atrophy and chronic inflammation in surgical specimens associated with survival in patients with resectable pancreatic ductal adenocarcinoma Taija Korpela1 Ari Ristimäki2 Marianne Udd1 Tiina Vuorela1 Harri Mustonen1 3 Caj Haglund1 3 Leena Kylänpää1 and Hanna Seppänen1 3 Abstract Background Pancreatic ductal adenocarcinoma PDAC one of the most lethal malignancies is increasing in incidence. However the stromal reaction pathophysiology and its role in PDAC development remain unknown. We therefore investigated the potential role of histological chronic pancreatitis findings and chronic inflammation on surgical PDAC specimens and disease-specific survival DSS . Methods Between 2000 and 2016 we retrospectively enrolled 236 PDAC patients treated with curative-intent pan- creatic surgery at Helsinki University Hospital. All pancreatic transection margin slides were re-reviewed and histologi- cal findings were evaluated applying international guidelines. Results DSS among patients with no fibrosis acinar atrophy or chronic inflammation identified on pathology slides was significantly better than DSS among patients with fibrosis acinar atrophy and chronic inflammation median survival 41.8 months 95 confidence interval CI 26.0 57.6 vs. 20.6 months 95 CI 10.3 30.9 log-rank test p 0.001 . Multivariate analysis revealed that Ca 19 9 gt 37 kU l hazard ratio HR 1.48 95 CI 1.02 2.16 lymph node metastases N1 2 HR 1.71 95 CI 1.16 2.52 tumor size gt 30 mm HR 1.47 95 CI 1.04 2.08 the combined effect of fibrosis and acinar atrophy HR 1.91 95 CI 1.27 2.88 and the combined effect of fibrosis acinar atrophy and chronic inflam- mation HR 1.63 95 CI 1.03 2.58 independently served as unfavorable prognostic factors for DSS. However we observed no significant associations between tumor size gt 30 mm and the degree of perilobular fibrosis p 0.655 intralobular fibrosis p