ASO Author Reflections: Does Site Matter? Impact of Tumor Location on Pathologic Characteristics, Recurrence, and Surviv
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Does Site Matter? Impact of Tumor Location on Pathologic Characteristics, Recurrence, and Survival of Resected Pancreatic Ductal Adenocarcinoma Giuseppe Malleo, MD, PhD1, Laura Maggino, MD1, Carlos Ferna`ndez-del Castillo, MD, FACS2, and Roberto Salvia, MD, PhD1 1
Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy; 2Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
PAST With increasing knowledge of the mechanisms of carcinogenesis, many solid tumors are no longer considered a unique disease. For example, colorectal cancer exhibits differences in incidence, clinical presentation, and molecular features and outcomes, depending on tumor location. This has been attributed to the fact that, embryologically, the left and right side of the colon are distinct.1 Although, in the pancreas, the dorsal and ventral buds do not differ embryologically, recent evidence suggests that body/tail pancreatic adenocarcinoma (PDAC) has peculiar clinical and molecular characteristics that may explain worse survival outcomes relative to head PDAC, as well as the later presentation in the disease process.2 PRESENT Under these premises, we compared pathologic features, recurrence pattern, and survival outcomes of 1466 patients with head PDAC and body/tail PDAC who underwent resection at two large academic facilities.3 Despite surprising differences in the pathologic profile found to be in favor of body/tail PDAC (lower rates of perineural invasion, G3/G4 grade, and N2 status), tumor location was not associated with survival at the adjusted analysis. Even the
timing and pattern of recurrence were independent of tumor location, with most events occurring at distant sites. There were certain prognostic factors specific to body/tail PDAC, including body mass index, preoperative pain, diabetes, and extended resections. Adjuvant therapy was significantly associated with improved survival in both groups. FUTURE Indeed, our results would suggest that site does not matter. How can these findings be reconciled with previous literature and what is the impact of these investigations in the foreseeable future? Discrepancies in the outcomes of patients undergoing resection could be at least partially explained by the selection process with respect to baseline characteristics, surgical attitude, and use of neoadjuvant therapy. Aside from this selection bias, we cannot exclude that, biologically, certain differences exist. Ultimately, forthcoming personalized platforms will help in outlining connections between tumor location, genotypic/phenotypic variations, and epigenetic events,4 with possible implications for addressing therapeutic strategies. DISCLOSURES Giuseppe Malleo, Laura Maggino, Carlos Ferna`ndez-del Castillo, and Roberto Salvia declare no conflicts of interest.
REFERENCES Ó Society of Surgical Oncology 2020 First Received: 30 April 2020; Published Online: 12 Ma
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