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

doi:10.1016/j.pan.2019.11.003

Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma

Pancreatology. 2020 Jan;20(1):110-115. doi: 10.1016/j.pan.2019.11.003. Epub 2019 Nov 14.

Authors

Thomas Malikowski¹, Heidi D Lehrke², Michael R Henry², Ferga C Gleeson³, Steven R Alberts⁴, Michael L Kendrick⁵, Ryan J Lennon⁶, Robert R McWilliams⁴, Naoki Takahashi⁷, Mark D Topazian³, Naveen Gara³, Barham K Abu Dayyeh³, Vinay Chandrasekhara³, Suresh T Chari³, Prasad G Iyer³, Elizabeth Rajan³, Andrew C Storm³, Kenneth K Wang³, Michael J Levy⁸

Affiliations

¹ Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
² Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
³ Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
⁴ Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
⁵ Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
⁶ Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
⁷ Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
⁸ Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Electronic address: levy.michael@mayo.edu.

PMID: 31759906
DOI: 10.1016/j.pan.2019.11.003

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.

Keywords: Celiac ganglia; EUS; Metastasis; Pancreatic ductal adenocarcinoma.

MeSH terms

Adenocarcinoma / pathology*
Adult
Aged
Carcinoma, Pancreatic Ductal / pathology*
Decision Making
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Female
Ganglia, Sympathetic / pathology*
Humans
Male
Middle Aged
Neoplasm Staging
Retrospective Studies