Tumour necrosis is a postoperative prognostic marker for pancreatic cancer patients with a high interobserver reproducibility in histological evaluation

N. Hiraoka, Y. Ino, S. Sekine, H. Tsuda, K. Shimada, T. Kosuge, J. Zavada, M. Yoshida, K. Yamada, T. Koyama, Y. Kanai

Research output: Contribution to journalReview articlepeer-review

62 Citations (Scopus)

Abstract

Background:Tumour necrosis reflects the presence of hypoxia, which can be indicative of an aggressive tumour phenotype. The aim of this study was to investigate whether histological necrosis is a useful predictor of outcome in patients with pancreatic ductal carcinoma (PDC).Methods:We reviewed histopathological findings in 348 cases of PDC in comparison with clinicopathological information. We counted small necrotic foci (micronecrosis) as necrosis, in addition to massive necrosis that had been only defined as necrosis in previous studies. The reproducibility of identifying histological parameters was tested by asking five independent observers to blindly review 51 examples of PDC.Results:Both micronecrosis and massive necrosis corresponded to hypoxic foci expressing carbonic anhydrase IX detected by immunohistochemistry. Multivariate survival analysis showed that histological necrosis was an independent predictor of poor outcome in terms of both disease-free survival (DFS) and disease-specific survival (DSS) of PDC patients. In addition, metastatic status, and lymphatic, venous, and intrapancreatic neural invasion were independent prognostic factors for shorter DFS and metastatic status, margin status, lymphatic invasion, and intrapancreatic neural invasion were independent prognostic factors for DSS. The interobserver reproducibility of necrosis identification among the five independent observers was almost perfect (-value of 0.87).Conclusion:Histological necrosis is a simple, accurate, and reproducible predictor of postoperative outcome in PDC patients.

Original languageEnglish
Pages (from-to)1057-1065
Number of pages9
JournalBritish Journal of Cancer
Volume103
Issue number7
DOIs
Publication statusPublished - 2010 Sep 28
Externally publishedYes

Keywords

  • hypoxia
  • interobserver reproducibility
  • necrosis
  • pancreatic cancer
  • prognostic factor

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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