A.I. BURNASYAN FMBC CLINICAL BULLETIN

ISSN 2782-6430 (print)

State Research Center −Burnasyan Federal Medical Biophysical
Center of Federal Medical Biological Agency

The journal is published in Russian.
Format – A4.
The periodicity of the journal is 4 times a year.

Issue №2 2025 год

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A.I. Burnasyan  FMBC clinical bulletin. 2023 № 4

E.A.Dubova, K.A.Pavlov

Grossing and Reporting of Pancreatic Ductal Adenocarcinoma Specimens after the Neoadjuvant Therapy

International Office, State Research Center – Burnasyan Federal Medical Biophysical Center

Contact person: Dubova Elena: dubovaea@gmail.com

Abstract
Pancreatic ductal adenocarcinoma is an aggressive tumor with poor prognosis and survival. Surgery is a treatment of choice for this tumors. Potentially resectable tumors are now treated with neoadjuvant therapy. This leads to necessity for pathologist to score the tumor response to neoadjuvant therapy. To date the international agreement guides for pathologic assessment of pancreatectomy specimens after neoadjuvant therapy are lack. Here we review the data on grossing and microscopic study of pancreatic ductal adenocarcinoma after neoadjuvant therapy, as well as data regarding the prognostic significance of tumor staging, therapy response and other pathologic parameters.

Keywords: pancreas, ductal adenocarcinoma, neoadjuvant therapy, tumor regress

For citation: Dubova EA, Pavlov KA. Grossing and Reporting of Pancreatic Ductal Adenocarcinoma Specimens After the Neoadjuvant Therapy. A.I. Burnasyan Federal Medical Biophysical Center Clinical Bulletin. 2023;4:19-25 (In Russian). DOI: 10.33266/2782-6430-2023-4-4-19-25 (In Russian). DOI: 10.33266/2782-6430-2023-4-4-19-25

 

REFERENCES

  1. Cronin KA, Scott S, Firth AU, Sung H, Henley SJ, Sherman RL, Siegel RL, Anderson RN, Kohler BA, Benard VB, Negoita S, Wiggins C, Cance WG, Jemal A. Annual report to the nation on the status of cancer, part 1: National cancer statistics. Cancer. 2022 Dec 15;128(24):4251-4284. doi: 10.1002/cncr.34479.
  2. Muniraj T, Barve P. Laparoscopic staging and surgical treatment of pancreatic cancer. N Am J Med Sci. 2013; 5: 1–9. doi: 10.4103/1947-2714.106183.
  3. Evans DB, Rich TA, Byrd DR, Cleary KR, Connelly JH, Levin B, Charnsangavej C, Fenoglio CJ, Ames FC. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992 Nov;127(11):1335-9. doi: 10.1001/archsurg.1992.01420110083017.
  4. Crane CH, Varadhachary G, Wolff RA, Pisters PAW, Evans DB. The argument for pre-operative chemoradiation for localized, radiographically resectable pancreatic cancer. Best Pract Res Clin Gastroenterol. 2006 Apr;20(2):365-82. doi: 10.1016/j.bpg.2005.11.005.
  5. O’Reilly EM, Perelshteyn A, Jarnagin WR, Schattner M, Gerdes H, Capanu M, Tang LH, LaValle J, Winston C, DeMatteo RP, D’Angelica M, Kurtz RC, Abou-Alfa GK, Klimstra DS, Lowery MA, Brennan MF, Coit DG, Reidy DL, Kingham TP, Allen PJ. A single-arm, nonrandomized phase II trial of neoadjuvant gemcitabine and oxaliplatin in patients with resectable pancreas adenocarcinoma. Ann Surg. 2014 Jul;260(1):142-8. doi: 10.1097/SLA.0000000000000251.
  6. Kalimuthu SN, Serra S, Dhani N, Hafezi-Bakhtiari S, Szentgyorgyi E, Vajpeyi R, Chetty R. Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study. J Clin Pathol. 2017;70(3):237–243. doi: 10.1136/jclinpath-2016-203947.
  7. Nagaria TS, Wang H, Chatterjee D, Wang H. Pathology of treatment pancreatic ductal adenocarcinoma and its clinical implications. Arch Pathol Lab Med. 2020 Jul 1;144(7):838-845. doi: 10.5858/arpa.2019-0477-RA.
  8. Soer E, Brosens L, van de Vijver M, Dijk F, van Velthuysen M-L, Farina-Sarasqueta A, Morreau H, Offerhaus J, Koens L, Verheij J. Dilemmas for the pathologist in the oncologic assessment of pancreatoduodenectomy specimens: An overview of different grossing approaches and the relevance of the histopathological characteristics in the oncologic assessment of pancreatoduodenectomy specimens. Virchows Arch. 2018 Apr;472(4):533-543. doi: 10.1007/s00428-018-2321-5.
  9. Verbeke CS, Gladhaug IP. Dissection of Pancreatic Resection Specimens. Surg Pathol Clin. 2016 Dec;9(4):523-538. doi: 10.1016/j.path.2016.05.001.
  10. Wang H, Chetty R, Hosseini M, Allende DS, Esposito I, Matsuda Y, Deshpande V, Shi J, Dhall D, Jang KT, Kim GE, Luchini C, Graham RP, Reid MD, Basturk O, Hruban RH, Krasinskas A, Klimstra DS, Adsay V; Pancreatobiliary Pathology Society. Pathologic Examination of Pancreatic Specimens Resected for Treated Pancreatic Ductal Adenocarcinoma: Recommendations From the Pancreatobiliary Pathology Society. Am J Surg Pathol. 2022 Jun 1;46(6):754-764. doi: 10.1097/PAS.0000000000001853.
  11. International Union Against Cancer (UICC). TNM classification of malignant tumours // Eds J.D. Brierley et al. -8th ed. – New York: Wiley-Blackwell, 2017
  12. Shi S, Hua J, Liang C, Meng Q, Liang D, Xu J, Ni Q, Yu X, . Proposed modification of the 8th edition of the AJCC staging system for pancreatic ductal adenocarcinoma. Ann Surg. 2019 May;269(5):944-950. doi: 10.1097/SLA.0000000000002668.
  13. Vuarnesson H, Lupinacci RM, Semoun O, Svrcek M, Julie C, Balladur P, Penna C, Bachet JB, Resche-Rigon M, Paye F. Number of examined lymph nodes and nodal status assessment in pancreaticoduodenectomy for pancreatic adenocarcinoma. Eur J Surg Oncol. 2013 Oct;39(10):1116-21. doi: 10.1016/j.ejso.2013.07.089.
  14. Amin MB, Edge S, Greene F, et al, eds. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer International Publishing; 2017.
  15. Burgart L. J., Chopp W.V., Jain D. Protocol for the examination of specimens  from patients with carcinoma of the pancreas. College of American Pathologists Web site. November, 2021 College of American Pathologists Web site. https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates
  16. Adsay NV, Basturk O, Altinel D, Khanani F, Coban I, Weaver DW, Kooby DA, Sarmiento JM, Staley C. The number of lymph nodes identified in a simple pancreatoduodenectomy specimen: comparison of conventional vs orange-peeling approach in pathologic assessment. Mod Pathol. 2009 Jan;22(1):107-12. doi: 10.1038/modpathol.2008.167.
  17. Chatterjee D, Katz MH, Foo WC, Sundar M, Wang H, Varadhachary G, Wolff RA, Lee JE, Maitra A, Fleming JB, Rashid A, Wang H. Prognostic significance of new AJCC tumor stage in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant therapy. Am J Surg Pathol. 2017 Aug;41(8):1097-1104. doi: 10.1097/PAS.0000000000000887.
  18. Provenzano E, Bossuyt V, Viale G, Cameron D, Badve S, Denkert C, MacGrogan G, Penault-Llorca F, Boughey J, Curigliano G, Dixon JM, Esserman L, Fastner G, Kuehn T, Peintinger F, von Minckwitz G, White J, Yang W, Symmans WF, Residual Disease Characterization Working Group of the Breast International Group. Standardization of pathologic evaluation and reporting of postneoadjuvant specimens in clinical trials of breast cancer: recommendations from an international working group. Mod Pathol. 2015 Sep;28(9):1185-201. doi: 10.1038/modpathol.2015.74.
  19. Ishikawa O, Ohhigashi H, Sasaki Y, Imaoka S, Iwanaga T, Teshima T, Chatani M, Inoue T, Fujita M, Tanaka S. The histopathological effect of preoperative irradiation in adenocarcinoma of the periampullary region. Nippon Gan Chiryo Gakkai Shi. 1988;23(3):720–727.
  20. White RR, Xie HB, Gottfried MR, Czito BG, Hurwitz HI, Morse MA, Blobe GC, Paulson EK, Baillie J, Branch MS, Jowell PS, Clary BM, Pappas TN, Tyler DS. Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer. Ann Surg Oncol. 2005 Mar;12(3):214-21. doi: 10.1245/ASO.2005.03.105.
  21. Chatterjee D, Katz MH, Rashid A, Varadhachary GR, Wolff RA, Wang H, Lee JE, Pisters PW, Vauthey JN, Crane C, Gomez HF, Abbruzzese JL, Fleming JB, Wang H. Histologic grading of the extent of residual carcinoma following neoadjuvant chemoradiation in pancreatic ductal adenocarcinoma: a predictor for patient outcome. Cancer. 2012 Jun 15;118(12):3182-90. doi: 10.1002/cncr.26651.
  22. Lee SM, Katz MH, Liu L, Sundar M, Wang H, Varadhachary GR, Wolff RA, Lee JE, Maitra A, Fleming JB, Rashid A, Wang H. Validation of a proposed tumor regression grading scheme for pancreatic ductal adenocarcinoma after neoadjuvant therapy as a prognostic indicator for survival. Am J Surg Pathol. 2016 Dec;40(12):1653-1660. doi: 10.1097/PAS.0000000000000738.
  23. Peng JS, Wey J, Chalikonda S, Allende DS, Walsh RM, Morris-Stiff G. Pathologic tumor response to neoadjuvant therapy in borderline resectable pancreatic cancer. Hepatobiliary Pancreat Dis Int. 2019 Aug;18(4):373-378. doi: 10.1016/j.hbpd.2019.05.007.
  24. Van den Broeck A, Sergeant G, Ectors N, Van Steenbergen W, Aerts R, Topal B. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2009 Jun;35(6):600-4. doi: 10.1016/j.ejso.2008.12.006.
  25. van Roessel S, Kasumova GG, Tabatabaie O, Ng SC, van Rijssen LB, Verheij J, Najarian RM, van Gulik TM, Besselink MG, Busch OR, Tseng JF. Pathological margin clearance and survival after pancreaticoduodenectomy in a US and European pancreatic center. Ann Surg Oncol. 2018 Jun;25(6):1760-1767. doi: 10.1245/s10434-018-6467-9.
  26. Verbeke CS. Resection margins in pancreatic cancer. Surg Clin North Am. 2013 Jun;93(3):647-62. doi: 10.1016/j.suc.2013.02.008.
  27. Liu L, Katz MH, Lee SM, Fischer LK, Prakash L, Parker N, Wang H, Varadhachary GR, Wolff RA, Lee JE, Pisters PW, Maitra A, Fleming JB, Estrella J, Rashid A, Wang H. Superior mesenteric artery margin of posttherapy pancreaticoduodenectomy and prognosis in patients with pancreatic ductal adenocarcinoma Am J Surg Pathol. 2015 Oct;39(10):1395-403. doi: 10.1097/PAS.0000000000000491.
  28. Lopez NE, Prendergast C, Lowy AM. Borderline resectable pancreatic cancer: definitions and management. World J Gastroenterol. 2014 Aug 21;20(31):10740-51. doi: 10.3748/wjg.v20.i31.10740.
  29. Abrams RA, Lowy AM, O’Reilly EM, Wolff RA, Picozzi VJ, Pisters PW. Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009 Jul;16(7):1751-6. doi: 10.1245/s10434-009-0413-9.
  30. Wang J, Estrella JS, Peng L, Rashid A, Varadhachary GR, Wang H, Lee JE, Pisters PWT, Vauthey J-N, Katz MH, Gomez HF, Evans DB, Abbruzzese JL, Fleming JB, Wang H. Histologic tumor involvement of superior mesenteric vein/portal vein predicts poor prognosis in patients with stage II pancreatic adenocarcinoma treated with neoadjuvant chemoradiation. Cancer. 2012 Aug 1;118(15):3801-11. doi: 10.1002/cncr.26717. 
  31. Ramacciato G, Nigri G, Petrucciani N, Pinna AD, Ravaioli M, Jovine E, Minni F, Grazi GL, Chirletti P, Tisone G, Napoli N, Boggi U. Pancreatectomy with mesenteric and portal vein resection for borderline resectable pancreatic cancer: multicenter study of 406 patients. Ann Surg Oncol. 2016 Jun;23(6):2028-37. doi: 10.1245/s10434-016-5123-5
  32. Prakash LR, Wang H, Zhao J, Nogueras-Gonzales GM, Cloyd JM, Tzeng C-WD, Kim MP, Lee JE, Katz MHG . Significance of cancer cells at the vein edge in patients with pancreatic adenocarcinoma following pancreatectomy with vein resection. J Gastrointest Surg. doi:10. 1007/s11605-019-04126-y.
  33. Ratnayake CBB, Shah N, Loveday B, Windsor JA, Pandanaboyana S. The impact of the depth of venous invasion on survival following pancreatoduodenectomy for pancreatic cancer: a meta-analysis of available evidence. J Gastrointest Cancer. doi:10.1007/s12029-019-00248-3.

 

Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Dubova E.A. – analysis of literature data, writing the text of the article
Pavlov K.A. –  text editing, approval of the final version of the manuscript text
Article received: 29.11.2023.  Accepted for publication: 15.12.2023

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