TY - JOUR
T1 - Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma
T2 - Celiac Ganglia Metastases
AU - Malikowski, Thomas
AU - Lehrke, Heidi D.
AU - Henry, Michael R.
AU - Gleeson, Ferga C.
AU - Alberts, Steven R.
AU - Kendrick, Michael L.
AU - Lennon, Ryan J.
AU - McWilliams, Robert R.
AU - Takahashi, Naoki
AU - Topazian, Mark D.
AU - Gara, Naveen
AU - Abu Dayyeh, Barham K.
AU - Chandrasekhara, Vinay
AU - Chari, Suresh T.
AU - Iyer, Prasad G.
AU - Rajan, Elizabeth
AU - Storm, Andrew C.
AU - Wang, Kenneth K.
AU - Levy, Michael J.
N1 - Publisher Copyright:
© 2019 IAP and EPC
PY - 2020/1
Y1 - 2020/1
N2 - Background: Pre-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). Patients: We 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. Results: Twenty-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). Conclusions: EUS-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.
AB - Background: Pre-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). Patients: We 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. Results: Twenty-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). Conclusions: EUS-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.
KW - Celiac ganglia
KW - EUS
KW - Metastasis
KW - Pancreatic ductal adenocarcinoma
UR - http://www.scopus.com/inward/record.url?scp=85076544599&partnerID=8YFLogxK
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U2 - 10.1016/j.pan.2019.11.003
DO - 10.1016/j.pan.2019.11.003
M3 - Article
C2 - 31759906
AN - SCOPUS:85076544599
SN - 1424-3903
VL - 20
SP - 110
EP - 115
JO - Pancreatology
JF - Pancreatology
IS - 1
ER -