Standardised histopathologic evaluation after pancreatoduodenectomy for adenocarcinoma : Resection margins, tumour origin, and survival
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AbstractPancreatic cancer is a lethal disease, and even after assumed margin-free pancreatoduodenectomy, most patients die within few years. The aims were to evaluate the importance of standardised histopathologic assessment for adequacy of reporting and survival estimates, and to report on prognostic factors in a setting of standardised histopathologic assessment. We performed immunohistochemical evaluation, slide review, and review of histopathologic reports from all pancreatoduodenectomies at Rikshospitalet University Hospital in 1980–2004. Reports from 1998-2004 at this institution were compared with reports from all other Norwegian institutions in the same period. Standardised histopathologic assessment and reporting was found necessary to avoid underestimation of poor prognostic factors, and to avoid misdiagnosis of tumours originating from non-pancreatic tissue (ampulla, distal bile duct, duodenum). Standardised histopathology was more important than surgical volume for completeness of reporting and for reliability of survival estimates, particularly with respect to lymph node evaluation. Immunostaining for MUC1 and MUC4 identified a subgroup of patients with particularly poor prognosis. Standardised histopathologic evaluation should be a first prerequisite to assure adequate histopathology after pancreatoduodenectomy. Immunostaining may identify tumour markers potentially targetable in future adjuvant treatments for pancreatic cancer.
List of papers
|I. Westgaard A, Tafjord S, Farstad IN, Cvancarova M, Eide TJ, Mathisen O, Clausen OP, Gladhaug IP. Resectable adenocarcinomas in the pancreatic head: the retroperitoneal resection margin is an independent prognostic factor. BMC Cancer. 2008;8:5 Publisher: Biomed Central PubMed abstract: PMID 18194510. The published version of this paper is available at: https://doi.org/10.1186/1471-2407-8-5|
|II. Westgaard A, Larønningen S, Mellem C, Eide TJ, Clausen OP, Møller B, Gladhaug IP. Are survival predictions reliable? Hospital volume versus standardisation of histopathologic reporting for accuracy of survival estimates after pancreatoduodenectomy for adenocarcinoma. European Journal of Cancer. Epub April 17, 2009. Publisher: Elsevier PubMed abstract: PMID 19376696. The published version of this paper is available at: https://doi.org/10.1016/j.ejca.2009.03.019|
|III. Westgaard A, Tafjord S, Farstad IN, Cvancarova M, Eide TJ, Mathisen O, Clausen OP, Gladhaug IP. Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer. 2008;8:170 Publisher: Biomed Central PubMed abstract: PMID 18547417. The published version of this paper is available at: https://doi.org/10.1186/1471-2407-8-170|
|IV. Westgaard A, Schjølberg AR, Cvancarova M, Eide TJ, Clausen OP, Gladhaug IP. Differentiation markers in pancreatic head adenocarcinomas: MUC1 and MUC4 expression indicates poor prognosis in pancreatobiliary differentiated tumours. Histopathology. 2009;54:337-47 PubMed abstract: PMID 19236510. The published version of this paper is available at: https://doi.org/10.1111/j.1365-2559.2009.03227.x|