Peritoneal washing cytology status as a crucial prognostic determinant in patients with localized pancreatic ductal adenocarcinoma who underwent curative-intent resection following preoperative chemoradiotherapy

TL;DR

This study shows that a positive peritoneal washing cytology result after preoperative treatment is a strong predictor of worse outcomes in pancreatic cancer patients.

Contribution

The study identifies peritoneal washing cytology as an independent prognostic factor in PDAC patients after preoperative chemoradiotherapy.

Findings

CY+ patients had significantly worse overall and recurrence-free survival compared to CY− patients.

CY+ was associated with higher CA19-9 levels, tumor location in the pancreatic body or tail, and capsule invasion.

CY+ was an independent prognostic factor for worse survival outcomes in multivariate analysis.

Abstract

Prognostic implications of peritoneal washing cytology (CY) in patients with localized pancreatic ductal adenocarcinoma (PDAC) undergoing surgical resection following preoperative chemoradiotherapy (CRT) remain unclear. This study aimed to elucidate the prognostic significance and predictors of a positive CY status (CY+) after preoperative CRT.

Clinical data from 141 patients with localized PDAC who underwent curative-intent resection after preoperative CRT were retrospectively analyzed to examine the association between CY+ and clinicopathological factors and survival.

CY+ was observed in six patients (4.3%). The CY+ group exhibited significantly higher preoperative serum levels of CA19-9 and a substantially greater incidence of tumor location in the pancreatic body or tail, along with pathological invasion to the anterior pancreatic capsule, than the CY− group. The CY+ group had a significantly higher incidence of peritoneal recurrence compared with the CY− group (83.3% vs. 18.5%, p = 0.002). Overall survival (OS) and recurrence-free survival (RFS) after surgery were significantly shorter in the CY+ group than in the CY− group (CY+ vs. CY−: 18.3 vs. 46.2 months, p = 0.001, and 8.9 vs. 17.7 months, p = 0.009, respectively). Multivariate analyses identified CY+ as an independent prognostic factor for worse OS (hazard ratio 5.00, 95% confidence interval 1.03–12.31) and RFS (hazard ratio 2.58, 95% confidence interval 1.04–6.43). Local invasion grade on imaging before CRT, limited histological response to CRT, and absence of adjuvant chemotherapy were independent predictors of worse OS and RFS.

Despite the relatively low incidence of CY+ after preoperative CRT, it emerged as an independent prognostic factor in patients with localized PDAC undergoing curative-intent resection following preoperative CRT.

Figures