Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma: Celiac Ganglia Metastases

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: Celiac Ganglia Metastases

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

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Pages (from-to)	110-115
Number of pages	6
Journal	Pancreatology
Volume	20
Issue number	1
DOIs	https://doi.org/10.1016/j.pan.2019.11.003
State	Published - Jan 2020

Keywords

Celiac ganglia
EUS
Metastasis
Pancreatic ductal adenocarcinoma

ASJC Scopus subject areas

Endocrinology
Endocrinology, Diabetes and Metabolism
Hepatology

Access to Document

10.1016/j.pan.2019.11.003

Cite this

Malikowski, T., Lehrke, H. D., Henry, M. R., Gleeson, F. C., Alberts, S. R., Kendrick, M. L., Lennon, R. J., McWilliams, R. R., Takahashi, N., Topazian, M. D., Gara, N., Abu Dayyeh, B. K., Chandrasekhara, V., Chari, S. T., Iyer, P. G., Rajan, E., Storm, A. C., Wang, K. K., & Levy, M. J. (2020). Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma: Celiac Ganglia Metastases. Pancreatology, 20(1), 110-115. https://doi.org/10.1016/j.pan.2019.11.003

Malikowski, T, Lehrke, HD, Henry, MR, Gleeson, FC, Alberts, SR, Kendrick, ML, Lennon, RJ, McWilliams, RR, Takahashi, N, Topazian, MD, Gara, N, Abu Dayyeh, BK, Chandrasekhara, V, Chari, ST, Iyer, PG, Rajan, E, Storm, AC, Wang, KK & Levy, MJ 2020, 'Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma: Celiac Ganglia Metastases', Pancreatology, vol. 20, no. 1, pp. 110-115. https://doi.org/10.1016/j.pan.2019.11.003

@article{a449fe08d25840d7b49d34f937f50b36,

title = "Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma: Celiac Ganglia Metastases",

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",

author = "Thomas Malikowski and Lehrke, {Heidi D.} and Henry, {Michael R.} and Gleeson, {Ferga C.} and Alberts, {Steven R.} and Kendrick, {Michael L.} and Lennon, {Ryan J.} and McWilliams, {Robert R.} and Naoki Takahashi and Topazian, {Mark D.} and Naveen Gara and {Abu Dayyeh}, {Barham K.} and Vinay Chandrasekhara and Chari, {Suresh T.} and Iyer, {Prasad G.} and Elizabeth Rajan and Storm, {Andrew C.} and Wang, {Kenneth K.} and Levy, {Michael J.}",

note = "Publisher Copyright: {\textcopyright} 2019 IAP and EPC",

year = "2020",

month = jan,

doi = "10.1016/j.pan.2019.11.003",

language = "English (US)",

volume = "20",

pages = "110--115",

journal = "Pancreatology",

issn = "1424-3903",

publisher = "S. Karger AG",

number = "1",

}

TY - JOUR

T1 - Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma

T2 - Celiac Ganglia Metastases

AU - Malikowski, Thomas

AU - Lehrke, Heidi D.

AU - Henry, Michael R.

AU - Gleeson, Ferga C.

AU - Alberts, Steven R.

AU - Kendrick, Michael L.

AU - Lennon, Ryan J.

AU - McWilliams, Robert R.

AU - Takahashi, Naoki

AU - Topazian, Mark D.

AU - Gara, Naveen

AU - Abu Dayyeh, Barham K.

AU - Chandrasekhara, Vinay

AU - Chari, Suresh T.

AU - Iyer, Prasad G.

AU - Rajan, Elizabeth

AU - Storm, Andrew C.

AU - Wang, Kenneth K.

AU - Levy, Michael J.

PY - 2020/1

Y1 - 2020/1

N2 - 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.

AB - 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.

KW - Celiac ganglia

KW - EUS

KW - Metastasis

KW - Pancreatic ductal adenocarcinoma

UR - http://www.scopus.com/inward/record.url?scp=85076544599&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076544599&partnerID=8YFLogxK

U2 - 10.1016/j.pan.2019.11.003

DO - 10.1016/j.pan.2019.11.003

M3 - Article

C2 - 31759906

AN - SCOPUS:85076544599

SN - 1424-3903

VL - 20

SP - 110

EP - 115

JO - Pancreatology

JF - Pancreatology

IS - 1

ER -

Clinical impact of celiac ganglia metastasis upon pancreatic ductal adenocarcinoma: Celiac Ganglia Metastases

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this