Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy: A nationwide, cancer registry-based study from the Japan Pancreas Society

Hiroyoshi Tsuchida¹, Tsutomu Fujii², Masamichi Mizuma³, Sohei Satoi⁴, Hisato Igarashi⁵, Hidetoshi Eguchi⁶, Tamotsu Kuroki⁷, Yasuhiro Shimizu⁸, Masaji Tani⁹, Satoshi Tanno¹⁰, Yoshihisa Tsuji¹¹, Yoshiki Hirooka¹², Atsushi Masamune¹³, Kazuhiro Mizumoto¹⁴, Takao Itoi¹⁵, Shinichi Egawa¹⁶, Yuzo Kodama¹⁷, Shin Hamada¹³, Michiaki Unno³, Hiroki Yamaue¹⁸, Kazuichi Okazaki¹⁹; Committee of Clinical Research, Japan Pancreas Society

Affiliations

¹ Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
² Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan. Electronic address: fjt@med.u-toyama.ac.jp.
³ Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
⁴ Department of Surgery, Kansai Medical University, Osaka, Japan.
⁵ Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁶ Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
⁷ Department of Surgery, National Hospital Nagasaki Medical Center, Nagasaki, Japan.
⁸ Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
⁹ Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
¹⁰ Department of Gastroenterology, IMS Sapporo Digestive Center General Hospital, Sapporo, Japan.
¹¹ Department of Clinical Education, Shiga University of Medical Science, Otsu, Japan.
¹² Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, Toyoake, Japan.
¹³ Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹⁴ Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁵ Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
¹⁶ Division of International Cooperation for Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan.
¹⁷ Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
¹⁸ Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
¹⁹ Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.

PMID: 31445763
DOI: 10.1016/j.surg.2019.06.023

Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy: A nationwide, cancer registry-based study from the Japan Pancreas Society

Hiroyoshi Tsuchida et al. Surgery. 2019 Dec.

. 2019 Dec;166(6):997-1003.

doi: 10.1016/j.surg.2019.06.023. Epub 2019 Aug 21.

Authors

Affiliations

¹ Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
² Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan. Electronic address: fjt@med.u-toyama.ac.jp.
³ Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
⁴ Department of Surgery, Kansai Medical University, Osaka, Japan.
⁵ Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁶ Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
⁷ Department of Surgery, National Hospital Nagasaki Medical Center, Nagasaki, Japan.
⁸ Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
⁹ Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
¹⁰ Department of Gastroenterology, IMS Sapporo Digestive Center General Hospital, Sapporo, Japan.
¹¹ Department of Clinical Education, Shiga University of Medical Science, Otsu, Japan.
¹² Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, Toyoake, Japan.
¹³ Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹⁴ Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁵ Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
¹⁶ Division of International Cooperation for Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan.
¹⁷ Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
¹⁸ Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
¹⁹ Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.

PMID: 31445763
DOI: 10.1016/j.surg.2019.06.023

Abstract

Background: The importance of peritoneal washing cytology status both as a sign of irresectability and as a prognostic factor for pancreatic ductal adenocarcinoma remains controversial. The purpose of this nationwide, cancer registry-based study was to clarify the clinical implications of operative resection in patients who had positive cytology status.

Methods: Clinical data from 1,970 patients who underwent tumor resection were collected from the Pancreatic Cancer Registry in Japan. Clinicopathologic factors and overall survival curves were analyzed, and multivariate Cox proportional hazard models were evaluated.

Results: Among the 1,970 patients analyzed, positive cytology status was found in 106 patients and negative cytology status was found in 1,864 patients. The positive cytology status group had a greater frequency of pancreatic body and tail cancer and greater preoperative serum carbohydrate antigen 19-9 levels than the negative cytology status group (P < .001 each). The ratio of peritoneal recurrence tended to be greater in the positive cytology status group (14% vs 43%; P < .001). Overall median survival times were less in the positive cytology status group (17.5 months vs 29.4 months; P < .001). The 5-year survival rates were 13.7% and 31.1% in the positive cytology status and negative cytology status groups, respectively. Multivariate analysis of positive cytology status patients revealed that adjuvant chemotherapy was an independent prognostic factor.

Conclusion: Positive cytology status was an adverse prognostic factor in patients who underwent resection for pancreatic ductal adenocarcinoma but did not preclude attempted curative resection. Curative resection followed by adjuvant chemotherapy may contribute to long-term prognosis in patients with positive cytology status.

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Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy: A nationwide, cancer registry-based study from the Japan Pancreas Society

Affiliations

Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy: A nationwide, cancer registry-based study from the Japan Pancreas Society

Authors

Affiliations

Abstract

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical