Annals of surgical oncology · 2026
Predictive Factors for Occult Metastases in Clinically M0 Pancreatic Cancer: A Prospective Multicenter Analysis of Staging Laparoscopy.
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Iseki Masahiro, Igarashi Takamichi, Takahashi Ryosuke, Mizuma Masamichi, Ariake Kyohei, Nakagawa Kei, Aoki Shuichi, Miura Takayuki, Maeda Shimpei, Ishida Masaharu, Shibuya Kazuto, Yoshioka Isaku, Kimura Nana, Watanabe Toru, Hirano Katsuhisa, Sugawara Shuichiro, Motoi Fuyuhiko, Fujii Tsutomu, Unno Michiaki
Аннотация
BACKGROUND: Staging laparoscopy (SL) is a minimally invasive approach for detecting occult metastases in patients with pancreatic cancer (PC) without signs of metastasis on imaging. This study aimed to identify the predictive factors for imaging-negative occult metastases.
METHODS: This prospective study enrolled 199 patients with histologically confirmed PC from three institutions between August 2021 and April 2023. All patients were scheduled for a treatment plan that included SL.
RESULTS: The overall metastasis rate as detected using SL was 25.1%, which varied from 20.6% in patients with resectable PC (R-PC) to 33.8% in those with borderline resectable or locally advanced unresectable PC (BR/URLA-PC). In 152 patients who did not receive neoadjuvant therapy, BR/URLA status (odds ratio 3.261; 95% confidence interval 1.185-9.483, p = 0.022) and pancreatic body/tail lesions (odds ratio 2.653; 95% confidence interval 1.037-7.214, p = 0.042) were independent risk factors for occult metastatic lesions (M1). Among the 107 patients with R-PC, M1 disease was significantly associated with pancreatic body/tail lesions, tumor size, and elevated levels of tumor markers. In particular, elevated carbohydrate antigen 19-9 levels were consistent across all patients with M1 pancreatic head cancer. In contrast, no statistical differences were observed for any of these factors in the 45 patients with BR/URLA-PC.
CONCLUSIONS: Our findings support the importance of SL in patients with BR/UR PC. For R-PC, patients with pancreatic head lesions and normal tumor marker values may represent a very low-risk subgroup where selective omission of SL can be considered in resource-constrained settings.
METHODS: This prospective study enrolled 199 patients with histologically confirmed PC from three institutions between August 2021 and April 2023. All patients were scheduled for a treatment plan that included SL.
RESULTS: The overall metastasis rate as detected using SL was 25.1%, which varied from 20.6% in patients with resectable PC (R-PC) to 33.8% in those with borderline resectable or locally advanced unresectable PC (BR/URLA-PC). In 152 patients who did not receive neoadjuvant therapy, BR/URLA status (odds ratio 3.261; 95% confidence interval 1.185-9.483, p = 0.022) and pancreatic body/tail lesions (odds ratio 2.653; 95% confidence interval 1.037-7.214, p = 0.042) were independent risk factors for occult metastatic lesions (M1). Among the 107 patients with R-PC, M1 disease was significantly associated with pancreatic body/tail lesions, tumor size, and elevated levels of tumor markers. In particular, elevated carbohydrate antigen 19-9 levels were consistent across all patients with M1 pancreatic head cancer. In contrast, no statistical differences were observed for any of these factors in the 45 patients with BR/URLA-PC.
CONCLUSIONS: Our findings support the importance of SL in patients with BR/UR PC. For R-PC, patients with pancreatic head lesions and normal tumor marker values may represent a very low-risk subgroup where selective omission of SL can be considered in resource-constrained settings.