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Clinical Outcome of Uncinate Process Cancer versus Non-Uncinate Process Pancreatic Head Cancer: A Singe Center Retrospective Study
Yun Bian1, Chao Ma1, Xu Fang1, Jin Li1, Kai Cao1, Li Wang1, Jin Gang2, Jianping Lu1, and Hui Jiang3
1Radiology, Changhai hospital, Shanghai, China, 2Pancreatic Surgery, Changhai hospital, Shanghai, China, 3Pathology, Changhai hospital, Shanghai, China

Synopsis

The uncinate process has unique anatomical characteristics, which may make cancers that develop there radiopathologically different from cancers that develope elsewhere in the pancreas. Previous studies on uncinate and non-uncinate process pancreatic head cancer have yielded conflicting results. Some investigators concluded that location of pancreatic head cancer did not correlate with prognosis. Meanwhile, other investigators demonstrated a significant association between tumor location and prognosis, showing that uncinate process pancreatic head cancer was associated with a higher mortality risk versus non-uncinate process pancreatic head cancer. However, it still remains unelucidated whether tumor location is an independent prognostic factor of overall survival (OS) of pancreatic head cancer patients. In addition, it is unclear whether tumor location could guide prognostic stratification of pancreatic head cancer patients. So, the primary objectives of our study were to investigate the relationship between uncinate and non-uncinate process pancreatic head cancer and overall survival (OS) and further explore prognostic stratification between the two tumor locations and OS in different subgroups of patients.

Objective Previous studies on uncinate and non-uncinate process pancreatic head cancer have yielded conflicting results. To investigate the relationship between uncinate and non-uncinate process pancreatic head cancer and overall survival (OS) and further explore prognostic stratification between the two tumor locations and OS in different subgroups of patients.
Methods We enrolled 150 patients with pathologically confirmed pancreatic cancer who underwent multislice computed tomography from October 2014 to December 2017. All patients were divided into the uncinate process cancer group and the non-uncinate process pancreatic head cancer group, and their all characteristics were retrospectively analyzed. Multivariable Cox proportional hazards models were used to analyze association with OS.
Results Patients with uncinate process cancer and non-uncinate process pancreatic head cancer accounted for 48% (n=72) and 52% (n=78) of the study cohort, respectively. OS differed significantly between the uncinate process cancer group and the non-uncinate process pancreatic head cancer group (p = 0.0143). In the two tumor locations, patients with neoadjuvant treatment had significantly longer OS than patients without neoadjuvant treatment (p < 0.0001), respectively. Lymphovascular space invasion (LVSI) played an interactive role in the association between tumor location and OS (p for interaction = 0.0002). Multivariate analyses revealed that patients with uncinate process cancer had a 2.75-fold (95% CI: 1.52-4.98) mortality risk compared to those with non-uncinate process pancreatic head cancer (p = 0.0008).
Conclusion Tumor location is an independent prognostic factor for an OS in pancreatic head cancer patients. Preoperative neoadjuvant treatment can significantly prolong OS. Keywords Pancreatic cancer; Pancreas agenesis, dorsal; Survival; Prognosis

Acknowledgements

Scientists of China (81871352), National Science Foundation for Young Scientists of China (81701689, 81601468), the 63-class General Financial Grant from the China Postdoctoral Science Foundation (2018M633714), Key Junior College of National Clinical of China, Shanghai Technology Innovation Project 2017 on Clinical Medicine (17411952200), Project of Precision Medical Transformation Application of NMMU (2017JZ42),and by Top Project of the Military Medical Science and Technology Youth Training Program (17QNP017).

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Figures

Figure 1 Identification of uncinate and non-uncinate process cancer.

Figure 2 Kaplan-Meier curve for OS.

Figure4 Subgroup analysis of the two locations of pancreatic head cancer and death risk according to clinical characteristics (A), pathological characteristics (B), and radiological characteristics (C).CI: confidence interval; HR: hazards ratio; -: the variables of n <10 in a category; LVSI, lymphovascular space invasion; PD, pancreatic duct; CBD: common bile duct; PV, portal vein; SMV, superior mesenteric vein; SMA, superior mesenteric artery.

Proc. Intl. Soc. Mag. Reson. Med. 28 (2020)
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