Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma |
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| Institution: | 1. Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA;2. Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA;3. Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA;4. Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA;5. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA;6. Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA;7. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA;1. Associate Professor of Gastroenterology, Department of Gastroenterology, Bahcelievler Memorial Hospital, Turkey;2. Tulane University, School of Medicine, Department of Medicine, Section of Gastroenterology and Hepatology, USA;3. Specialist of Gastroenterology and Internal Medicine, Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Turkey;4. Specialist of Internal Medicine, Department of Internal Medicine, Sisli Hamidiye Etfal Education and Research Hospital, Turkey;5. Associate Professor of of Pathology, Department of Pathology, Sisli Hamidiye Etfal Education and Research Hospital, Turkey;6. Associate Professor of of Medical Biochemistry, Department of Biochemistry, Sisli Hamidiye Etfal Education and Research Hospital, Turkey;7. Professor of of Radiology, Department of Radiology, Sisli Hamidiye Etfal Education and Research Hospital, Turkey;8. Professor of Gastroenterology, Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Turkey;1. School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy;2. Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico G.B. Rossi, University of Verona Hospital Trust, Verona, Italy;3. Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital and University, Rozzano, Milan, Italy;4. Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;1. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;2. Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;3. Sheikh Ahmed Center for Pancreatic Cancer Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;4. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;1. Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia;2. College of Medicine and Public Health, Flinders University, South Australia, Australia;1. Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan;2. Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan;3. Department of Hepato-Biliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan;1. Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;2. Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;3. Cancer Center, Massachusetts General Hospital, Boston, MA, USA;4. Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA |
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| Abstract: | BackgroundPre-operative staging of pancreatic adenocarcinoma guides clinical decision making. Limited data indicate that metastasis to celiac ganglia (CG) correlates with poor prognosis. We investigated feasibility and safety of endoscopic ultrasound fine needle aspiration (EUS-FNA) detection of CG metastasis and its impact upon tumor stage, resectability, and survival in pancreatic ductal adenocarcinoma (PDAC).PatientsWe reviewed our prospectively maintained EUS and cytopathology databases to identify patients with FNA proven CG metastasis in patients with PDAC from 2004 to 2017. Clinical demographics, EUS, CT, MRI, cytopathology, cancer stage, and resectability data were analyzed. Survival of PDAC patients with CG metastasis was compared to the expected survival of PDAC patients of similar stage as reported by the United States National Cancer Database.ResultsTwenty-one patients with PDAC median age 73 (IQR63-78); 14 (67%) female)], had CG metastasis confirmed by cytopathologic assessment. CG metastasis resulted in tumor upstaging relative to other EUS findings and cross sectional imaging findings in 12 (57%) and 15 (71%) patients, and converted cancers from resectable to unresectable relative to EUS and cross sectional imaging in 7 (37%) and 7 (37%) patients, respectively. In patients with PDAC, the survival of patients with CG metastasis was not significantly different from the overall survival (hazard ratio 0.71; 95% confidence interval 0.44, 1.13; p = 0.15).ConclusionsEUS-FNA may safely identify CG metastases. While CG metastasis upstaged and altered the resectability status among this cohort of patients with PDAC, the survival data with regard to PDAC suggest that this may be misguided. |
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| Keywords: | Pancreatic ductal adenocarcinoma EUS Celiac ganglia Metastasis Celiac ganglia"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"CG endoscopic ultrasound"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"EUS fine needle aspiration"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"FNA pancreatic ductal adenocarcinoma"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"PDAC |
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