Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2025
Clinical importance of suspicious for malignancy compared to positive for malignancy in peritoneal cytology for surgically resected pancreatic cancer.
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Tanaka Haruyoshi, Hirabayashi Kenichi, Fujii Tsutomu, Ohike Nobuyuki, Ueno Makoto, Mizui Takahiro, Ishida Masaharu, Egawa Shinichi, Furukawa Toru, Nagakawa Yuichi, Itoi Takao, Kitagawa Hirohisa, Masugi Yohei, Tani Masaji, Fukushima Noriyoshi, Hatori Takashi, Tajika Yosuke, Satoi Sohei, Unno Michiaki, Takeyama Yoshifumi
Аннотация
BACKGROUND/OBJECTIVES: Positive peritoneal cytology (Cy+) is considered a form of microscopic dissemination and a poor prognostic factor in resected pancreatic cancer (PC). However, the clinical implications of equivocal categories such as atypia of undetermined significance (AUS) and suspicious for malignancy (SFM) remain unclear.
METHODS: We retrospectively analyzed patients with PC who underwent surgery at 13 high-volume centers between January 2009 and December 2018. Inclusion criteria were: 1) cytology results of AUS, SFM, or malignant (MAL); 2) resectable (R) or borderline resectable (BR); 3) no other macroscopic metastases; and 4) no preoperative therapy.
RESULTS: A total of 239 cases were included (AUS: 58, SFM: 31, MAL: 150), with R/BR = 196/43. Survival curves for SFM closely resembled those for MAL but differed from AUS. Grouped analysis showed that SFM + MAL patients had significantly shorter median overall survival (OS) than AUS patients (19.6 vs. 28.0 months, HR 1.61, P < 0.01) and shorter recurrence-free survival (RFS: 8.0 vs. 12.7 months, HR 1.53, P = 0.01). This trend persisted in resectable cases (OS: 21.1 vs. 30.5 months, HR 1.74; RFS: 9.1 vs. 14.2 months, HR 1.57; all P < 0.01).
CONCLUSIONS: The cytology of SFM in PC is associated with a prognosis comparable to that of MAL, suggesting the need for cautious clinical interpretation and potential reclassification.
METHODS: We retrospectively analyzed patients with PC who underwent surgery at 13 high-volume centers between January 2009 and December 2018. Inclusion criteria were: 1) cytology results of AUS, SFM, or malignant (MAL); 2) resectable (R) or borderline resectable (BR); 3) no other macroscopic metastases; and 4) no preoperative therapy.
RESULTS: A total of 239 cases were included (AUS: 58, SFM: 31, MAL: 150), with R/BR = 196/43. Survival curves for SFM closely resembled those for MAL but differed from AUS. Grouped analysis showed that SFM + MAL patients had significantly shorter median overall survival (OS) than AUS patients (19.6 vs. 28.0 months, HR 1.61, P < 0.01) and shorter recurrence-free survival (RFS: 8.0 vs. 12.7 months, HR 1.53, P = 0.01). This trend persisted in resectable cases (OS: 21.1 vs. 30.5 months, HR 1.74; RFS: 9.1 vs. 14.2 months, HR 1.57; all P < 0.01).
CONCLUSIONS: The cytology of SFM in PC is associated with a prognosis comparable to that of MAL, suggesting the need for cautious clinical interpretation and potential reclassification.