Reproducibility and prognostic significance of area of residual tumor (ART) in post-neoadjuvant resections of pancreatic ductal adenocarcinoma |
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| Affiliation: | 1. Oncology Pathology, Faculty of Medicine, Kagawa University, Japan;2. Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Japan;3. Department of Radiology, Faculty of Medicine, Kagawa University, Japan;4. Department of Clinical Oncology, Faculty of Medicine, Kagawa University, Japan;5. Department of Hygiene, Faculty of Medicine, Kagawa University, Japan;6. Department of Pathology II, Kochi University, Japan;7. Division of Diagnostic Pathology, Ehime University Hospital, Japan;8. Division of Pathology, Tokushima University Hospital, Japan;9. Department of Pathology, Japanese Red Cross Medical Center, Japan;10. Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Japan;11. Department of Pathology, Massachusetts General Hospital and Harvard Medical School, USA;1. Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan;2. Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan;3. Division of Pathology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan;4. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan;1. Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA;2. Division of Epidemiology, Mayo Clinic, Jacksonville, FL, USA;3. Division of Biostatistics, Mayo Clinic, Jacksonville, FL, USA;4. Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA;1. Department of Pathology, Kochi Medical School, Kochi 783-8505, Japan;2. Department of Urology, Kochi Medical School, Kochi 783-8505, Japan;3. Department of Physiology, Nippon Medical School Graduate School of Medicine, Tokyo 113-8602, Japan;1. Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China;2. Department of Pancreas Surgery, Zhongshan Hospital, Fudan University, 200032, Shanghai, China;1. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA;2. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA;3. Department of Medicine, Ohio State University, Columbus, OH, USA;4. Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA;5. Alcohol Research Group, Emeryville, CA, USA;6. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;7. Division of Gastroenterology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA |
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| Abstract: | ![]()
BackgroundThe pathologic assessments of tumor response after neoadjuvant chemoradiotherapy (NACRT) are critical to improving the prognostic stratification for patients with pancreatic ductal adenocarcinoma (PDAC). Here we clarified the utility of our new grading system based on the area of residual tumor (ART) as compared to existing systems, such as the College of American Pathologists (CAP) and MD Anderson (MDA) score. Methods: Eight reviewers individually evaluated the tumor regression grade of 30 patients with PDAC based on three types of grading systems. The interobserver concordance and clinicopathological characteristics were compared between the three systems. Results: The interobserver concordance (kappa value) of the ART, CAP, and MDA score were 0.61, 0.48, and 0.53, respectively. Discrepant cases, which were 27% of the cases, exhibited smaller tumor and tumor bed sizes than concordant cases. The reduction in tumor size evaluated by microscopy showed a correlation with the rate of change in carcinoembryonic antigen (CEA) level, CA19-9 level, and tumor size on computed tomography (CT). The ART score was correlated with the tumor size on CT before and after NACRT and disease-free survival. The CAP and MDA scores were not associated with prognosis. Conclusion: The ART grading system may be the most practical system to assess the tumor response in post-NACRT resections of PDAC. |
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| Keywords: | Pancreatic cancer Neoadjuvant chemoradiotherapy Tumor regression grade Area of residual tumor Interobserver concordance |
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