• Annals of surgery · Oct 2024

    Morphologic Characterization of Pancreatic Ductal Adenocarcinoma following Post-neoadjuvant Pancreatectomy and Clinical value of Intratumor Heterogeneity.

    • Gabriella Lionetto, Paola Mattiolo, Calogero Ciulla, Giulia Savegnago, Fabio Casciani, Matteo De Pastena, Salvatore Paiella, Antonio Pea, Alessandro Esposito, Anna Crovetto, Massimo Donadelli, Carlotta Franzina, Matteo Fassan, Aldo Scarpa, Roberto Salvia, Giuseppe Malleo, and Claudio Luchini.
    • University of Verona, Italy.
    • Ann. Surg. 2024 Oct 15.

    ObjectiveTo evaluate the morphologic landscape of pancreatic ductal adenocarcinoma (PDAC), intratumor spatial heterogeneity, and the resulting clinical impact following post-neoadjuvant pancreatectomy.Summary Background DataThe clinical value of PDAC morphologic subtypes and intratumor spatial heterogeneity post-treatment remains an open issue.Materials And MethodsThe study cohort included patients who underwent post-neoadjuvant pancreatectomy for PDAC at the University of Verona Hospital Trust between 2013 and 2019. All hematoxylin and eosin-stained slides were reviewed to assess PDAC histomorphology and intratumor heterogeneity. The relationship with other clinicopathological variables, overall survival (OS), and recurrence-free (RFS) survival was evaluated using standard statistics.ResultsThe study cohort included 400 patients. Histological revision identified ten different morphologic subtypes. Gland-forming PDAC with a conventional pattern was the most frequently identified subtype (41.8%). Overall, 247 tumors (61.7%) showed only one histological pattern and were classified as homogeneous, whereas 153 (38.3%) showed different morphologies and were classified as heterogeneous tumors. The median post-resection survival was 30.1 months (95%CI 26.6-33.5). There was a substantial survival variability according to the morphologic subtype, ranging from 19.1 months in the gyriform subtype to 47.0 months in the papillary subtype. Tumors with a heterogeneous morphology displayed a higher rate of nodal metastases, worse tumor regression metrics, and worse oncologic outcomes relative to spatially homogeneous tumors.DiscussionThis paper provided a morphological taxonomy of residual tumors following post-neoadjuvant pancreatectomy for PDAC. The morphologic subtype and intratumor spatial heterogeneity have relevant prognostic implications and could be included in the pathology report to complement regression metrics.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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