title: Superior prognostic importance of perineural invasion vs. lymph node involvement after curative resection of duodenal adenocarcinoma.
abstract: BACKGROUND
  Unlike other gastrointestinal tumors, lymph node involvement has not consistently been a negative prognostic factor for survival in patients with duodenal adenocarcinoma. Our aim is to examine prognostic factors in patients who underwent a curative resection of their duodenal adenocarcinoma.
  
  
  METHODS
  A retrospective review of 169 patients diagnosed with primary duodenal lesions between 1982 and 2010 was performed, of whom 103 were treated with curative intent. Clinico-pathologic factors were evaluated.
  
  
  RESULTS
  A potentially curative resection was performed in 103 patients with a median age of 67 years (range, 22-91). Perineural and lympho-vascular invasion were identified in 30 (29.1%) and 39 patients (37.9%), respectively. Median follow-up was 26.5 months. The 5-year overall survival was 62% vs. 25% for patients with or without nodal metastases (p < 0.001) and 56% vs. 19% for patients with or without perineural invasion (p < 0.001), respectively. Lymph node ratio, type of resection, and size of tumor failed to stratify prognosis. By multivariate analysis, perineural invasion was the most powerful independent predictor of survival (HR, 2.520; CI, 1.361-4.664).
  
  
  CONCLUSIONS
  Perineural invasion is a stronger predictor for recurrence and survival than tumor size, depth of infiltration, lymph node involvement, and type of resection in patients with duodenal adenocarcinoma.
authors: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors: Stefano
authors: S
authors: Cecchini
authors: Camilo
authors: C
authors: Correa-Gallego
authors: Vikram
authors: V
authors: Desphande
authors: Matteo
authors: M
authors: Ligorio
authors: Abdulmetin
authors: A
authors: Dursun
authors: Jennifer
authors: J
authors: Wargo
authors: Carlos
authors: C
authors: Fernàndez-del Castillo
authors: Andrew Louis
authors: AL
authors: Warshaw
authors: Cristina Rosa
authors: CR
authors: Ferrone
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy; D010525:Peripheral Nerves / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D055815:Young Adult