title: Histologic tumor involvement of superior mesenteric vein/portal vein predicts poor prognosis in patients with stage II pancreatic adenocarcinoma treated with neoadjuvant chemoradiation.
abstract: BACKGROUND
  Studies have shown that superior mesenteric vein (SMV)/portal vein (PV) resection with pancreaticoduodenectomy (PD) is safe and feasible for patient with pancreatic adenocarcinoma (PAC). However, the prognostic significance of tumor involvement of the resected vein in patients who received neoadjuvant therapy is unclear.
  
  
  METHODS
  The authors evaluated 225 consecutive patients with stage II PAC who received neoadjuvant therapy and PD with or without SMV/PV resection. The resected SMV/PV was entirely submitted for histologic assessment and reviewed in all cases. Tumor involvement of the SMV/PV was correlated with clinicopathologic features and survival.
  
  
  RESULTS
  Among the 225 patients, SMV/PV resection was performed in 85 patients. Histologic tumor involvement of the resected SMV/PV was identified in 57 patients. Histologic tumor involvement of the SMV/PV was associated with larger tumor size, higher rates of positive margin, and local/distant recurrence. By multivariate analysis, tumor involvement of the SMV/PV was an independent predictor of both disease-free survival (DFS) and overall survival (OS). However, addition of venous resection to PD itself had no impact on either DFS or OS compared with those with PD alone.
  
  
  CONCLUSIONS
  Histologic tumor involvement of the SMV/PV is an independent predictor of both DFS and OS in patients with stage II PAC treated with neoadjuvant therapy and PD. Complete histologic evaluation of the resected SMV/PV is important for the prognosis in patients with PAC who received neoadjuvant therapy and PD.
authors.affiliation: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Jiansheng
authors.initials: J
authors.lastname: Wang
authors.forename: Jeannelyn S
authors.initials: JS
authors.lastname: Estrella
authors.forename: Lan
authors.initials: L
authors.lastname: Peng
authors.forename: Asif
authors.initials: A
authors.lastname: Rashid
authors.forename: Gauri R
authors.initials: GR
authors.lastname: Varadhachary
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Katz
authors.forename: Henry F
authors.initials: HF
authors.lastname: Gomez
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: James L
authors.initials: JL
authors.lastname: Abbruzzese
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Huamin
authors.initials: H
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology*; D011169:Portal Vein / Q000473:pathology; D011379:Prognosis; D016019:Survival Analysis