Alignment of stroma fibers, microvessel density and immune cell populations determine overall survival in pancreatic cancer-An analysis of stromal morphology

Introduction

The aim of this study was to define histo-morphological stroma characteristics by analyzing stromal components, and to evaluate their impact on local and systemic tumor spread and overall survival in pancreatic ductal adenocarcinoma (PDAC).

Methods and materials

Patients who underwent oncologic resections with curative intent for PDAC were identified from a prospectively maintained database. Histological specimens were re-evaluated for morphological stroma features as stromal fibers, fibroblast morphology, stroma matrix density, microvessel density and distribution of immune cell populations.

Results

A total of 108 patients were identified undergoing curative resection for PDAC in the period from 2011–2016. 33 (30.6%) patients showed parallel alignment of stroma fibers while 75 (69.4%) had randomly oriented stroma fibers. As compared to parallel alignment, random orientation of stroma fibers was associated with larger tumor size (median 3.62 cm vs. median 2.87cm, p = 0.037), nodal positive disease (76.0% vs. 54.5%, p = 0.040), higher margin positive resection rates (41.9% vs. 15.2%, p = 0.008) and a trend for higher rates of T3/4 tumors (33.3% vs. 15.2%, p = 0.064). In univariate analysis, patients with parallel alignment of stroma fibers had improved overall survival rates as compared to patients with random orientation of stroma fibers (42 months vs. 22 months, p = 0.046). The combination of random orientation of stroma fibers and low microvessel density was associated with impaired overall survival rates (16 months vs. 36 months, p = 0.019). A high CD4/CD3 ratio (16 months vs. 33 months, p = 0.040) and high stromal density of CD163 positive cells were associated with reduced overall survival (27 months vs. 34 months, p = 0.039). In multivariable analysis, the combination of random orientation of stroma fibers and low microvessel density (HR 1.592, 95%CI 1.098–2.733, p = 0.029), high CD4/CD3 ratio (HR 2.044, 95%CI 1.203–3.508, p = 0.028) and high density of CD163 positive cells (HR 1.596, 95%CI 1.367–1.968, p = 0.036) remained independent prognostic factors.

Conclusion

Alignment of stroma fibers and microvessel density are simple histomorphological features serving as surrogate markers of local tumor progression dissemination and surgical resectability and determine prognosis in PDAC patients. High CD4/CD3 ratio and CD163 positive cell counts determine poor prognosis.

FACTORS INFLUENCING RECOVERY AFTER PANCREATODUODENECTOMY: UNICENTER EXPERIENCE

Our purpose was to determine the incidence of pancreatic fistula (POPF) and delayed gastric emptying (DGE), assess impact of these and other potential factors of influence on overall survival. We analyzed 97 patients who underwent pancreaticoduodenectomy between 2012 and 2018 years. POPF grade B was present in 7 (7,1%) and grade C in 8 (8,2%). DGE grade B was present in 15 (15,3%) and grade C in 7 (7,1%). Patients with POPF grade C had lower OS, compared to others (p=0,0005). DGE had a significant association with POPF (χ²=9,5; p=0,003). Furthermore, we didn't prove impact of DGE grade, grade of tumor differentiation, T and N status, histological subtype (adenocarcinomas vs. other types) on OS (р=0,63, p=0,1054, p=0,7, p=0,74 and p=0,193 respectively). Therefore, POPF, especially grade C, is accompanied by a decrease in OS of patientsafter PD and is associated with DGE. DGE, tumor differentiation, T and N indices, and histological type of the tumor have no influence on OS.

Efficacy of ukrain in the treatment of pancreatic cancer

BACKGROUND

This monocentric study evaluated the effect of ukrain in the treatment of pancreatic cancer.

MATERIAL AND METHODS

Between January 1996 and December 1999 we treated 21 patients with 10 mg ukrain every second day x10. The control group received supportive treatment only.

RESULTS

Ukrain treatment was well tolerated. Mean values on pain measure and Karnofsky index were significantly better in the ukrain group than in controls ( P<0.05). One-year survival was 76% in the ukrain group, compared to 9.5% in the control group. Median survival after treatment with ukrain was 574 days, compared to 197 days in the control group.

CONCLUSIONS

Our data demonstrate that ukrain improves quality of life in patients suffering from advanced pancreatic cancer and significantly prolongs survival time in these patients.