DOCSLIB.ORG

Effect of Marital Status on Duodenal Adenocarcinoma Survival: a Surveillance Epidemiology and End Results Population Analysis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Effect of Marital Status on Duodenal Adenocarcinoma Survival: a Surveillance Epidemiology and End Results Population Analysis 1904 ONCOLOGY LETTERS 18: 1904-1914, 2019 Effect of marital status on duodenal adenocarcinoma survival: A Surveillance Epidemiology and End Results population analysis NA WANG1,2*, QINGTING BU3*, QINGQING LIU1,4, JIN YANG1,4, HAIRONG HE1, JIE LIU2, XUEQUN REN5,6 and JUN LYU1 1Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061; 2School of Nursing and Health, Henan University, Kaifeng, Henan 475001; 3Department of Genetics, Northwest Women's and Children's Hospital; 4School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061; 5Center for Evidence-Based Medicine and Clinical Research; 6Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan 475000, P.R. China Received September 15, 2018; Accepted May 23, 2019 DOI: 10.3892/ol.2019.10475 Abstract. Numerous studies have shown that marital status at stages II, III or IV. The survival outcomes for duodenal may be a prognostic factor in various malignancies, but little adenocarcinoma are improved in married patients compared is known about its effect on duodenal adenocarcinoma. The with those in unmarried patients. Therefore, attention should aim of the present study was to determine the association be paid to the impact of social factors and socio-economic between marital status and survival in patients with duodenal factors on unmarried patients, in order to improve their adenocarcinoma. The Surveillance, Epidemiology and End survival outcomes. Results database was utilized to analyze 2,018 patients who had been diagnosed with duodenal adenocarcinoma between Introduction January 2004 and December 2015. Kaplan-Meier and Cox regression analyses were also used to determine the impact Duodenal adenocarcinoma that originates in the mucosal of marital status on overall survival (OS) and cause‑specific epithelium is the most common type of duodenal tumor and survival (CSS). The 5-year OS rate was higher in married in 2014 accounted for 15-25% of cases of cancer of the small patients (32.6%) compared with unmarried (26.8%) patients intestine in the United States (1). However, <1% of all cases of (P<0.001), as was the 5-year CSS rate (38.8 vs. 33.7%; gastrointestinal cancer are diagnosed as duodenal adenocarci- P<0.001). Multivariate analysis demonstrated that marital noma, and this may be due to the duodenum being the shortest status was an independent prognostic factor for duodenal part of the small intestine (2,3). The primary treatment for adenocarcinoma, with married patients having improved duodenal adenocarcinoma is surgery, with pancreatoduode- OS (P<0.001) and CSS (P=0.001) compared with unmarried nectomy and segmental resection being the most commonly patients. Subgroup analysis showed that marital status played used (4). The rarity of this condition means that there is no a role in the survival of patients at American Joint Committee consensus about the best adjuvant treatment strategy (5), and on Cancer Tumor-Node-Metastasis stage I, but not of patients the scope of resection for duodenal adenocarcinoma remains controversial (6). Previous studies have suggested that regional lymph node metastasis is associated with lower survival rates in patients with duodenal adenocarcinoma (7-9). However, prognostic factors such as age, sex, tumor size, pathology Correspondence to: Dr Jun Lyu, Clinical Research Center, The grade and American Joint Committee on Cancer (AJCC) First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Tumor-Node-Metastasis (TNM) stage were not consistent West Road, Xi'an, Shaanxi 710061, P.R. China E-mail: [email protected] with that result (10). Furthermore, relatively little is known about the effect of marital status on the outcome of duodenal Mr. Xuequn Ren, Department of General Surgery, Huaihe Hospital adenocarcinoma, and the data that is available may be affected of Henan University, 115 West Gate Street, Kaifeng, Henan 475000, by the small sample size (11). P. R. Ch i na Extra emphasis is now being placed on the role of social E-mail: [email protected] determinants in disease development (12). Social support *Contributed equally forms an important part of patient screening, treatment and follow-up care. It has been suggested that spouses tend to Key words: duodenal adenocarcinoma, marital status, overall encourage early screening and adherence to treatment, thereby survival, cause-specific survival, Surveillance Epidemiology and improving outcomes (13). Therefore, the potential importance End Results of social conditions should not be ignored in patients with duodenal adenocarcinoma, especially given that married patients reportedly have improved survival outcomes in breast, WANG et al: MARITAL STATUS AFFECTS DUODENAL ADENOCARCINOMA SURVIVAL 1905 ovarian, colon, and head and neck cancer (11,14-16). According unmarried (including never married, unmarried, divorced, to a previous study based on information in the Surveillance, separated and widowed). Epidemiology and End Results (SEER) database, married patients are more likely to be diagnosed with earlier stages Statistical analysis. Patient characteristics between the two of cancer and therefore, the treatment regimens may be more groups were compared, and it was determined whether the effective compared with those in unmarried patients (11). continuous variables conformed to a normal distribution; The aim of the present study was to elucidate the effects those that did are expressed as the mean ± SD, whereas those of marital status on the prognosis of patients with duodenal that did not are expressed as median values with the 25 and adenocarcinoma. The study investigated the impact of marital 75th percentiles provided. Continuous variables with a normal status on both overall survival (OS) and cause-specific distribution were statistically compared using Student's t‑test. survival (CSS) by analyzing demographic data obtained from Continuous variables that were not normally distributed the SEER database. were statistically compared using a Mann-Whitney U test. The categorical variables were compared using Pearson's χ2 Materials and methods test. OS and CSS were calculated using Kaplan-Meier plots method and a log-rank test was used to compare differences Patient population and study design. Sponsored by the between the groups in the Kaplan-Meier plots. A Cox propor- National Cancer Institute, the SEER program collects demo- tional-hazards model was constructed to identify factors that graphic, clinicopathological and survival data on a per-patient were independently associated with the prognosis. Cox multi- basis from 18 cancer registries across the United States, Hawaii variate analysis included age as a categorical variable (≤58, and Alaska (17). The SEER database (https://seer.cancer. 59‑75 and >75 years). The two‑sided probability values were gov/seerstat/software/)was used to identify 2,018 patients calculated. P<0.05 was considered to indicate a statistically with adenocarcinoma of the duodenum diagnosed between significant difference. All statistical analyses were performed January 2004 and December 2015. Primary cancer site and using SPSS (version 24.0; IBM Corp.). histology were coded according to the criteria in the third edition of the International Classification of Diseases for Results Oncology (18). Major loci and morphological code C17.0 were used to define tumors localized to duodenum, and the Baseline characteristics. A total of 2,018 eligible patients histological recode broad groupings were used to identify the with duodenal adenocarcinoma diagnosed between 2004 and nature of the tumor. Codes 8140‑8389 were used to define 2015 were identified in the SEER database. Table I shows the adenomas and adenocarcinomas. Patients were excluded baseline characteristics of the patients stratified by marital if the duodenal adenocarcinoma was not the first primary status. Of the 2,018 patients, 1,227 (60.80%) were married tumor, the marital status was unknown, the age at diagnosis and 791 (39.20%) were unmarried, with median ages of 67 was <18 years or there was missing information on ethnicity, and 69 years, respectively. The married group was comprised pathological grade, surgery, AJCC TNM stage or follow-up of considerably more males than females (63.33 vs. 36.67%), time. The primary outcomes of the present study were OS and whereas the opposite was true in the unmarried group CSS, which were defined as time until death from any cause (37.04 vs. 62.96%). There were large proportions of white and time until death caused by duodenal adenocarcinoma after patients in the married and unmarried groups (79.38 and diagnosis of duodenal adenocarcinoma, respectively. Death 66.62%, respectively), and also large proportions of patients attributed to duodenal adenocarcinoma was regarded as an who had received surgical interventions (64.38 and 56.89, event. Patients who died from other causes or were still alive respectively). There were statistically significant intergroup at the end of the last follow-up in December 2015 were treated differences with regard to age (P<0.001), sex (P<0.001), as censored observations. ethnicity (P<0.001), AJCC TNM stage (P<0.001) and surgical details (P=0.001). Study variables. The demographic and clinicopathological data were extracted from the SEER database, including year Marital status and OS. Survival differed according to marital of diagnosis, age, sex, ethnicity, marital status, pathological status (P<0.001), as shown by the Kaplan-Meier curve for OS grade, AJCC TNM stage and surgery versus no surgery. in Fig. 1A. OS time was higher in married patients compared Patients were divided into three groups according to the age with that in unmarried patients, with median values of 22 and at diagnosis (≤58, 59‑75 and >75 years), into four groups 12 months, respectively. Similarly, the 5-year OS rate was higher according to the year of diagnosis (2004-2006, 2007-2009, in married patients compared with that in unmarried patients 2010-2012 and 2013-2015) and into three groups according to (32.6 vs. 26.8%). In univariate analysis, all variables were ethnicity (Caucasian, African descent and others).
Load more

Recommended publications
  • The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Inherited Polyposis Syndromes Daniel Herzig, M.D
    CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Inherited Polyposis Syndromes Daniel Herzig, M.D. • Karin Hardimann, M.D. • Martin Weiser, M.D. • Nancy Yu, M.D. Ian Paquette, M.D. • Daniel L. Feingold, M.D. • Scott R. Steele, M.D. Prepared by the Clinical Practice Guidelines Committee of The American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Surgeons METHODOLOGY (ASCRS) is dedicated to ensuring high-quality pa- tient care by advancing the science, prevention, and These guidelines are built on the last set of the ASCRS T Practice Parameters for the Identification and Testing of management of disorders and diseases of the colon, rectum, Patients at Risk for Dominantly Inherited Colorectal Can- and anus. The Clinical Practice Guidelines Committee is 1 composed of society members who are chosen because they cer published in 2003. An organized search of MEDLINE have demonstrated expertise in the specialty of colon and (1946 to December week 1, 2016) was performed from rectal surgery. This committee was created to lead interna- 1946 through week 4 of September 2016 (Fig. 1). Subject tional efforts in defining quality care for conditions related headings for “adenomatous polyposis coli” (4203 results) to the colon, rectum, and anus, in addition to the devel- and “intestinal polyposis” (445 results) were included, us- opment of Clinical Practice Guidelines based on the best ing focused search. The results were combined (4629 re- available evidence. These guidelines are inclusive and not sults) and limited to English language (3981 results), then prescriptive.
    [Show full text]
  • Guidelines for the Management of Patients with Pancreatic Cancer
    v1 GUIDELINES Guidelines for the management of patients with pancreatic Gut: first published as 10.1136/gut.2004.057059 on 11 May 2005. Downloaded from cancer periampullary and ampullary carcinomas Pancreatic Section of the British Society of Gastroenterology, Pancreatic Society of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, Royal College of Pathologists, Special Interest Group for Gastro-Intestinal Radiology ............................................................................................................................... Gut 2005;54(Suppl V):v1–v16. doi: 10.1136/gut.2004.057059 1.0 GUIDELINES—SUMMARY lymph node metastases. Variants of ductal DOCUMENT carcinomas and other malignant tumours of The following recommendations are introduced the pancreas are rare. by brief statements which summarise the evi- dence and discussion presented in the relevant section of the full text of the guidelines. Recommendations 1.1 Incidence, mortality rates, and N Proper recognition of variants of ductal aetiology carcinomas and other malignant tumours Pancreatic cancer is an important health problem of the pancreas require specialist pathol- for which no simple screening test is available. ogical expertise (grade C). The strongest aetiological association is with N The minimum data set proposed by the cigarette smoking, although at risk groups Royal College of Pathologists (see appen- include patients with chronic pancreatitis, adult dix for details) should be used for report- onset
    [Show full text]
  • Duodenal Carcinoma from a Duodenal Diverticulum Mimicking Pancreatic Carcinoma
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Okayama University Scientific Achievement Repository Acta Med. Okayama, 2012 Vol. 66, No. 5, pp. 423ﾝ427 CopyrightⒸ 2012 by Okayama University Medical School. Case Report http ://escholarship.lib.okayama-u.ac.jp/amo/ Duodenal Carcinoma from a Duodenal Diverticulum Mimicking Pancreatic Carcinoma Masashi Furukawaa＊, Sadanobu Izumib, Kazunori Tsukudaa, Masaki Tokumoc, Jun Sakuraid, and Shohey Manoe aDepartment of Thoracic Surgery, Okayama University Hospital, Okayama 700-8558, Japan, Departments of bSurgery, dDiagnostic Radiology, ePathology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan, and cDepartment of Surgery, National Hospital Organization Minami-Okayama Medical Center, Hayashima-cho, Okayama 701-0304, Japan An 81-year-old man was found to have a pancreatic head tumor on abdominal computed tomography (CT) performed during a follow-up visit for sigmoid colon cancer. The tumor had a diameter of 35mm on the CT scan and was diagnosed as pancreatic head carcinoma T3N0M0. The patient was treated with pylorus-preserving pancreaticoduodenectomy. Histopathological examination showed that the tumor had grown within a hollow structure, was contiguous with a duodenal diverticulum, and had partially invaded the pancreas. Immunohistochemistry results were as follows: CK7 negative, CK20 positive, CD10 negative, CDX2 positive, MUC1 negative, MUC2 positive, MUC5AC negative, and MUC6 negative. The tumor was diagnosed as duodenal carcinoma from the duodenal diverticu- lum. Preoperative imaging showed that the tumor was located in the head of the pancreas and was compressing the common bile duct, thus making it appear like pancreatic cancer. To the best of our knowledge, this is the second report of a case of duodenal carcinoma from a duodenal diverticulum mimicking pancreatic carcinoma.
    [Show full text]
  • Prevention and Management of Duodenal Polyps in Familial Adenomatous Polyposis
    RECENT ADVANCES IN CLINICAL PRACTICE PREVENTION AND MANAGEMENT OF DUODENAL POLYPS IN FAMILIAL Gut: first published as 10.1136/gut.2004.053843 on 10 June 2005. Downloaded from 1034 ADENOMATOUS POLYPOSIS L A A Brosens, J J Keller, G J A Offerhaus, M Goggins, F M Giardiello Gut 2005;54:1034–1043. doi: 10.1136/gut.2004.053843 amilial adenomatous polyposis (FAP) is one of two well described forms of hereditary colorectal cancer. The primary cause of death from this syndrome is colorectal cancer which inevitably Fdevelops usually by the fifth decade of life. Screening by genetic testing and endoscopy in concert with prophylactic surgery has significantly improved the overall survival of FAP patients. However, less well appreciated by medical providers is the second leading cause of death in FAP, duodenal adenocarcinoma. This review will discuss the clinicopathological features, management, and prevention of duodenal neoplasia in patients with familial adenomatous polyposis. c FAMILIAL ADENOMATOUS POLYPOSIS FAP is an autosomal dominant disorder caused by a germline mutation in the adenomatous polyposis coli (APC) gene. FAP is characterised by the development of multiple (>100) adenomas in the colorectum. Colorectal polyposis develops by age 15 years in 50% and age 35 years in 95% of patients. The lifetime risk of colorectal carcinoma is virtually 100% if patients are not treated by colectomy.1 Patients with FAP can also develop a wide variety of extraintestinal findings. These include cutaneous lesions (lipomas, fibromas, and sebaceous and epidermoid cysts), desmoid tumours, osteomas, occult radio-opaque jaw lesions, dental abnormalities, congenital hypertrophy of the retinal pigment epithelium, and nasopharyngeal angiofibroma.
    [Show full text]
  • The Characteristics and Outcomes of Small Bowel Adenocarcinoma: a Multicentre Retrospective Observational Study
    FULL PAPER British Journal of Cancer (2017) 117, 1607–1613 | doi: 10.1038/bjc.2017.338 Keywords: small bowel; small intestine; adenocarcinoma The characteristics and outcomes of small bowel adenocarcinoma: a multicentre retrospective observational study Hiroyuki Sakae1, Hiromitsu Kanzaki*,1, Junichiro Nasu1,2, Yutaka Akimoto1, Kazuhiro Matsueda3, Masao Yoshioka2, Masahiro Nakagawa4, Shinichiro Hori5, Masafumi Inoue6, Tomoki Inaba7, Atsushi Imagawa8, Masahiro Takatani9, Ryuta Takenaka10, Seiyu Suzuki11, Toshiyoshi Fujiwara12 and Hiroyuki Okada1 1Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan; 2Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-Ku, Okayama 700-8511, Japan; 3Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan; 4Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-Ku, Hiroshima 730-8518, Japan; 5Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime 791-0280, Japan; 6Department of Gastroenterology, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-Ku, Okayama 700-8607, Japan; 7Department of Gastroenterology, Kagawa Prefectural Central Hospital, 5-4-6 Ban-cho, Takamatsu, Kagawa 760-8557, Japan; 8Department of Gastroenterology, Mitoyo General Hospital, 708 Himehama, Kanonji,
    [Show full text]
  • Cancer Surgeries in the Time of COVID-19: a Message from the SSO President and President-Elect
    Cancer Surgeries in the Time of COVID-19: A Message from the SSO President and President-Elect March 23, 2020 Dear SSO Members, In these unprecedented times, we are forced to consider triage and rationing of cancer surgery cases. Here are a few of the reasons: • the potential shortage of supplies, such as masks, gowns, gloves • the potential shortage of hospital personnel due to sickness, quarantine and duties at home • the potential shortage of hospital beds, ICU beds and ventilators • the desire to maximize social distancing amongst our patients, colleagues and staff. We have asked each of the SSO Disease Site Work Group Chairs and Vice Chairs to provide their recommendations for managing care in their specialties, assuming a 3- to 6-month delay in care. We have summarized their recommendations below. Numerous organizations are publishing in-depth guidelines, such as the NCCN, ACS, and ASCO, and we will provide links to those documents on the SSO Website. We have also instituted a COVID-19 community discussion page in My SSO Community for members to share what is happening in their institutions. In the next few days, SSO will produce a series of podcasts featuring discussions with experts, regarding their opinions and institutional practices. These podcasts will be available on SSO’s Website, iTunes, Sticher and other podcast platforms. Please watch your email and SSO’s Twitter and Facebook pages for details. The Annals of Surgical Oncology will be publishing an editorial on this topic soon. As each institution across the world is experiencing this pandemic at different levels, the timing of rationing care will vary and must be decided locally.
    [Show full text]
  • Prognostic Factors for Survival of Patients with Ampullary Carcinoma After Local Resection
    UPPER GI ANZJSurg.com Prognostic factors for survival of patients with ampullary carcinoma after local resection Xiangqian Zhao, Jiahong Dong, Xiaoqiang Huang, Wenzhi Zhang and Kai Jiang Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China Key words Abstract ampullary cancer, local resection, pathology, prognosis. Background: Local resection (LR) is a potentially effective alternative to Correspondence pancreaticoduodenectomy for treatment of ampullary cancer, but the prognostic Professor Jiahong Dong, Hospital and Institute of factors remain undefined. The purpose of this study was to identify the prognostic Hepatobiliary Surgery, Chinese PLA General Hospital, factors for ampullary cancer patients who had undergone LR. 28 Fuxing Road, Beijing 100853, China. Methods: We retrospectively reviewed the clinical, pathological data and surgical Email: [email protected] approach of 34 ampullary cancer patients who had undergone LR during 1996–2009 X. Zhao MD; J. Dong MD, PhD; X. Huang MD; at People’s Liberation Army General Hospital. Prognostic factors for survival and W. Zhang MD; K. Jiang MD. recurrence were analysed. Results: The 1-, 3- and 5-year survival rates of the patients were 97.1, 69.5 and 53.7%, Accepted for publication 3 March 2014. respectively. The gender, age, preoperative bilirubin levels, CA19-9 levels and preop- erative biopsy did not correlate with the survival rates. The survival rates of patient doi: 10.1111/ans.12600 with T1 and T2 tumours were superior to that of patients with T3 tumours (P = 0.000). Tumour size, surgical margin status and the extent of differentiation had no effect on survival rates (P = 0.464, P = 0.601 and P = 0.121, respectively).
    [Show full text]
  • 52198-Primary-Duodenal-Periampullary-Adenocarcinoma-An-Uncommon-Presentation.Pdf
    Open Access Case Report DOI: 10.7759/cureus.14323 Primary Duodenal Periampullary Adenocarcinoma: An Uncommon Presentation Rasiq Zackria 1, 2 , Mahesh Botejue 2 , Andrew W. Hwang 1, 2 1. Internal Medicine, University of California, Riverside School of Medicine, Riverside, USA 2. Graduate Medical Education, Riverside Community Hospital, Riverside, USA Corresponding author: Rasiq Zackria, [email protected] Abstract Periampullary carcinoma is a broad term used to define the group of carcinomas arising from the head of the pancreas, the distal common bile duct, and the duodenum. It is clinically important to differentiate ampullary from periampullary carcinoma as this can affect resectability and prognosis. Atypical left-sided chest pain is an atypical presentation of periampullary duodenal adenocarcinoma. A 58-year-old man presented with a two-month duration of worsening intermittent, atypical, migratory left-sided chest pain. Imaging studies were unremarkable; however, endoscopic evaluation demonstrated a duodenal mass. While most periampullary carcinomas are generally curable with pancreaticoduodenectomy, if left untreated, these tumors are uniformly fatal. Categories: Gastroenterology, General Surgery, Oncology Keywords: periampullary carcinoma, duodenal neoplasm Introduction Periampullary carcinoma is a broad term used to define the group of carcinomas arising from the head of the pancreas, the distal common bile duct, and the duodenum. Overall, periampullary carcinoma accounts for more than 30,000 deaths per annum in the United States. This neoplasia should be differentiated from ampullary carcinoma, as periampullary carcinoma tumor is anatomically centered in the region of the ampulla of Vater and the duodenal portion of the bile and pancreatic duct. It is clinically important to differentiate ampullary from periampullary carcinoma as this can affect resectability and prognosis.
    [Show full text]
  • Morphological Patterns of Primary Nonendocrine Human Pancreas Carcinoma'
    [CANCER RESEARCH 35, 2234-2248, August 1975] Morphological Patterns of Primary Nonendocrine Human Pancreas Carcinoma' Antonio L Cubifla and Patrick J. Fitzgerald2 Department of Pathology, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, New York UX@21 Summary the parenchymal cells. In the subsequent 5 decades terms such as mucous adenocarcinoma, colloid carcinoma, duct The study of histological sectionsof 406 casesof nonen adenocarcinoma, pleomorphic cancer, papillary adenocar docrine pancreas carcinoma at Memorial Hospital mdi cinoma, cystadenocarcinoma, and other variants, such as cated that morphological patterns of pancreas carcinoma epidermoid carcinoma, mucoepidermoid cancer, giant-cell could be delineated as follows: duct cell adenocarcinoma carcinoma, adenoacanthoma, and acinar cell carcinoma, (76%), giant-cell carcinoma (5%), microadenocarcinoma have appeared (7, 18, 23, 47, 62). Subtypes of islet-cell (4%), adenosquamous carcinoma (4%), mucinous adeno tumors have been defined (27). As pointed out by Baylor carcinoma (2%), anaplastic carcinoma (2%), cystadenocar and Berg (5) in discussing the limitations of their study of cinoma ( 1%), acinar cell carcinoma (1 %), carcinoma in 5000 patients with pancreas cancer from 8 cancer registries, childhood (under 1%), unclassified (7%). few pathologists precisely characterize the microscopic In 195 cases of patients with pancreas carcinoma, search features of their cases. was made for changes in the pancreas duct epithelium and We have reviewed cases of cancer of the pancreas at these were compared to duct epithelium in a control group Memorial Hospital to determine whether there are defina of 100 pancreases from autopsies of patients with nonpan ble morphological subgroups and to indicate their relative creatic cancer. The following incidences were found for distribution in our material.
    [Show full text]
  • Resource for Management Options of GI and HPB Cancers During COVID-19
    Resource for Management Options of GI and HPB Cancers During COVID-19 DATE: March 30, 2020 SSO supports the need for treatment decisions to be made on a case-by-case basis. The surgeon’s knowledge and understanding of the biology of each cancer, alternative treatment options, and the institution’s policies at the time the patient will be scheduled for surgery all need to be taken into consideration. The information below is based on the opinions of individuals who are experts within the field of gastrointestinal and hepato-pancreato-biliary cancers and are members of the Society’s Gastrointestinal and Hepato-pancreato-biliary Disease Site Work Groups. Upper Gastrointestinal Cancer Most gastrointestinal cancer surgery is not elective. If there are inadequate resources to manage potential complications, then surgery may need to be delayed or, if necessary, referred to centers with resources to perform the procedure. Discussion of cases at multi-disciplinary tumor board (virtual or otherwise performed in a setting limiting exposure) remains critical to discuss priorities, resources, and personalized treatment plans based on hospital, patient, and tumor specifics in this environment. Gastric and esophageal cancer • cT1a lesions amenable to endoscopic resection may preferentially undergo endoscopic management where resources are available • cT1b cancers should be resected • cT2 or higher and node positive tumors should be treated with neoadjuvant systemic therapy. • Staging laparoscopy with peritoneal washings is often utilized for patients being considered for neoadjuvant treatment. Given the recent concerns of laparoscopic surgery in COVID-19 patients and the additional use of resources, consideration may be given to proceeding straight to neoadjuvant treatment in COVID-19 positive patients, and if staging laparoscopy is decided to be performed, efforts to minimize PPE utilized and staff involved / exposed in the procedure should be made using appropriate pneumoperitoneum risk reduction strategies.
    [Show full text]
  • 5 Pancreatic and Periampullary Carcinoma (Nonendocrine)
    CHAPTER 5 Pancreatic and Periampullary Carcinoma (Nonendocrine) TAYLOR A. SOHN • CHARLES J. YEO Ductal adenocarcinoma is the most common primary atic cancer, a risk approximately 30 to 40% higher than malignant disease of the pancreas and periampullary re- that observed in whites.2 gion. It accounts for more than 75% of all nonendocrine In population studies in the United States, pancreatic tumors arising in this region, which includes the pan- cancer occurs more frequently among Jews than among creas, the ampulla of Vater, the distal common bile duct, Roman Catholics or Protestants. A similar pattern is ob- and the perivaterian duodenum. Pancreatic adenocarci- served among Jews and non-Jews in Israel. Mormons in noma is the most common of the periampullary neo- Utah have been reported to have a lower incidence of plasms. In the United States, the annual incidence of pancreatic and other smoking-related cancers. However, pancreatic cancer is 9 cases per 100,000 population; this decrease is also seen in non-Mormons living in Utah, it ranks eleventh among all cancers and ninth among a finding suggesting that environmental factors may play nondermatologic cancers. It remains the most lethal can- a significant role. Some evidence indicates that migrant cer, with an overall 5-year survival rate of less than 3% and status is a risk factor. Immigrants from Japan have a a death-to-incidence ratio of approximately 0.99. Because threefold higher risk of developing pancreatic cancer more than 28,000 persons in the United States are ex- than do children born in the United States of Japanese pected to die of pancreatic cancer in 2000, it is the fifth immigrant parents and a 1.7-fold higher risk than whites leading cause of cancer deaths in this country.1 This in the United States.2 chapter largely focuses on pancreatic adenocarcinoma.
    [Show full text]
  • Confirmatory Clinicopathological Analysis of 198
    Bronsert et al. BMC Cancer 2013, 13:428 http://www.biomedcentral.com/1471-2407/13/428 RESEARCH ARTICLE Open Access Intestinal-type of differentiation predicts favourable overall survival: confirmatory clinicopathological analysis of 198 periampullary adenocarcinomas of pancreatic, biliary, ampullary and duodenal origin Peter Bronsert1, Ilona Kohler1, Martin Werner1, Frank Makowiec2, Simon Kuesters2, Jens Hoeppner2, Ulrich Theodor Hopt2, Tobias Keck2,3, Dirk Bausch2,3 and Ulrich Friedrich Wellner2,3* Abstract Background: Periampullary adenocarcinomas comprise pancreatic, distal bile duct, ampullary and duodenal adenocarcinoma. The epithelia of these anatomical structures share a common embryologic origin from the foregut. With steadily increasing numbers of pancreatoduodenectomies over the last decades, pathologists, surgeons and oncologists are more often confronted with the diagnosis of “other than pancreatic” periampullary cancers. The intestinal subtype of ampullary cancer has been shown to correlate with better prognosis. Methods: Histological subtype and immunohistochemical staining pattern for CK7, CK20 and CDX2 were assessed for n = 198 cases of pancreatic ductal, distal bile duct, ampullary and duodenal adenocarcinoma with clinical follow- up. Routine pathological parameters were included in survival analysis performed with SPSS 20. Results: In univariate analysis, intestinal subtype was associated with better survival in ampullary, pancreatic ductal and duodenal adenocarcinoma. The intestinal type of pancreatic ductal adenocarcinoma
    [Show full text]