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Preop EUS-FNA does not increase mortality risk in resected pancreatic cancer
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Preoperative endoscopic ultrasound-guided fine needle aspiration was not associated with worse survival in patients with resected pancreatic cancer and instead pointed to “improved outcomes,” according to recent study data.
“The study was designed to address a long-standing hypothesis that preoperative biopsy may cause cancers to spread, and thus negatively affect outcomes,” Michael B. Wallace, MD, from the division of gastroenterology and hepatology at Mayo Clinic in Jacksonville, Fla., told Healio Gastroenterology. “We evaluated a large cohort of patients with pancreas cancer who did or did not have preoperative endoscopic ultrasound-guided fine needle aspiration, and then underwent complete surgical resection.”
Michael B. Wallace
Wallace and colleagues used the linked Surveillance, Epidemiology and End Results (SEER) database to identify a total of 2,034 eligible locoregional pancreatic cancer patients (90% with pancreatic adenocarcinoma) who underwent curative intent surgery from 1998 to 2009, 24% of whom received endoscopic ultrasound-guided fine needle aspiration (EUS-FNA).
“While adjusting for all other major factors (such as cancer stage, and location), we found no evidence of a negative impact on survival, in fact the opposite,” Wallace said. “Patients who had preoperative EUS-FNA fared better than those that didn’t.”
Median overall survival estimated by the Kaplan-Meier method was 22 months (95% CI, 18.8-25.2) among patients who received EUS-FNA compared with 15 months (95% CI, 13.9-16.1) in patients who did not. Multivariate analysis showed that EUS-FNA was slightly associated with improved overall survival (HR = 0.84; 95% CI, 0.72-0.99), but not cancer-specific survival (HR = 0.87; 95% CI, 0.74-1.03).
“We further explored whether biopsy of tumors in the tail of pancreas, where the needle pathway via the stomach and retroperitoneum is not resected in the surgical specimen, and compared it to pancreas head tumors, where the needle pathway is resected in a Whipple operation,” Wallace said. “If FNA caused tumor spread, outcomes should be worse with pancreas tail FNA. Again we found no evidence to support a negative impact of EUS-FNA.”
Multivariate analysis showed no difference in overall survival for patients who underwent EUS-FNA with head disease (HR = 0.86; 95% CI, 0.73-1.01) or body/tail disease (HR = 0.8; 95% CI, 0.51-1.26), and also no difference in cancer-specific survival for patients who underwent EUS-FNA with head disease (HR = 0.89; 95% CI, 0.75-1.07) or body/tail disease (HR = 0.86; 95% CI, 0.54-1.39).
“In summary, we found the preoperative FNA is associated with improved outcomes in surgically resected pancreas cancer and found no evidence that it causes tumor spread,” he said. – by Adam Leitenberger
Disclosure: Wallace reports he receives research funding unrelated to this study from COSMO Pharmaceuticals, Olympus, Boston Scientific, Ninepoint and US Endoscopy.
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