Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma

Thomas Malikowski, Heidi D. Lehrke, Michael R. Henry, Ferga C. Gleeson, Steven R. Alberts, Michael L. Kendrick, Ryan J. Lennon, Robert R. McWilliams, Naoki Takahashi, Mark D. Topazian, Naveen Gara, Barham K. Abu Dayyeh, Vinay Chandrasekhara, Suresh T. Chari, Prasad G. Iyer, Elizabeth Rajan, Andrew C. Storm, Kenneth K. Wang, Michael J. Levy

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalPancreatology
DOIs
StateAccepted/In press - Jan 1 2019

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Sympathetic Ganglia
Adenocarcinoma
Neoplasm Metastasis
Survival
Neoplasms
Fine Needle Biopsy
Databases
Demography
Confidence Intervals

Keywords

  • Celiac ganglia
  • EUS
  • Metastasis
  • Pancreatic ductal adenocarcinoma

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

Cite this

Malikowski, T., Lehrke, H. D., Henry, M. R., Gleeson, F. C., Alberts, S. R., Kendrick, M. L., ... Levy, M. J. (Accepted/In press). Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma. Pancreatology. https://doi.org/10.1016/j.pan.2019.11.003

Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma. / Malikowski, Thomas; Lehrke, Heidi D.; Henry, Michael R.; Gleeson, Ferga C.; Alberts, Steven R.; Kendrick, Michael L.; Lennon, Ryan J.; McWilliams, Robert R.; Takahashi, Naoki; Topazian, Mark D.; Gara, Naveen; Abu Dayyeh, Barham K.; Chandrasekhara, Vinay; Chari, Suresh T.; Iyer, Prasad G.; Rajan, Elizabeth; Storm, Andrew C.; Wang, Kenneth K.; Levy, Michael J.

In: Pancreatology, 01.01.2019.

Research output: Contribution to journalArticle

Malikowski, T, Lehrke, HD, Henry, MR, Gleeson, FC, Alberts, SR, Kendrick, ML, Lennon, RJ, McWilliams, RR, Takahashi, N, Topazian, MD, Gara, N, Abu Dayyeh, BK, Chandrasekhara, V, Chari, ST, Iyer, PG, Rajan, E, Storm, AC, Wang, KK & Levy, MJ 2019, 'Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma', Pancreatology. https://doi.org/10.1016/j.pan.2019.11.003
Malikowski, Thomas ; Lehrke, Heidi D. ; Henry, Michael R. ; Gleeson, Ferga C. ; Alberts, Steven R. ; Kendrick, Michael L. ; Lennon, Ryan J. ; McWilliams, Robert R. ; Takahashi, Naoki ; Topazian, Mark D. ; Gara, Naveen ; Abu Dayyeh, Barham K. ; Chandrasekhara, Vinay ; Chari, Suresh T. ; Iyer, Prasad G. ; Rajan, Elizabeth ; Storm, Andrew C. ; Wang, Kenneth K. ; Levy, Michael J. / Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma. In: Pancreatology. 2019.
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abstract = "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.",
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author = "Thomas Malikowski and Lehrke, {Heidi D.} and Henry, {Michael R.} and Gleeson, {Ferga C.} and Alberts, {Steven R.} and Kendrick, {Michael L.} and Lennon, {Ryan J.} and McWilliams, {Robert R.} and Naoki Takahashi and Topazian, {Mark D.} and Naveen Gara and {Abu Dayyeh}, {Barham K.} and Vinay Chandrasekhara and Chari, {Suresh T.} and Iyer, {Prasad G.} and Elizabeth Rajan and Storm, {Andrew C.} and Wang, {Kenneth K.} and Levy, {Michael J.}",
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T1 - Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma

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.

PY - 2019/1/1

Y1 - 2019/1/1

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

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