Hum Pathol. 2020 Nov 24. pii: S0046-8177(20)30238-0. [Epub ahead of print]
Pancreatic ductal adenocarcinoma is aggressive, with an overall five-year survival rate of 9%, and few patients are candidates for pancreatectomy at presentation. The role of neoadjuvant therapy (NAT) is evolving, especially for high-risk potentially resectable tumors. Due to the increasing number of NAT resection specimens, we aim to characterize the histologic changes associated with NAT, and to compare two tumor regression grading schemes. 118 resections for pancreatic ductal adenocarcinoma were selected from the cases between 2011-2018, 59 not treated and 59 treated with NAT. All H&E stained tumor slides were reviewed for histologic changes and graded using the four-tier modified Ryan score (recommended by College of American Pathologists) and the three-tier MD Anderson score. The histologic changes evaluated included blue/grey fibrosis, islet cell hyperplasia, dystrophic calcification, amyloid deposition, cholesterol clefts, nerve hypertrophy, elastotic stromal/vascular change, abscess formation, and eosinophilic tumor cell changes. There were statistically significant differences for dystrophic calcification, eosinophilic tumor cell changes, elastotic stromal/vascular change, islet cell hyperplasia, and nerve hypertrophy between the two groups, with these features seen more frequently in NAT cases. Blue/grey stromal fibrosis was present in all cases regardless of NAT, except few complete regression cases and one treated case with intraneural invasion only. Blue/grey fibrosis is a useful histologic visual clue to suggest the possibility of adjacent tumor in the majority of PDAC cases regardless of NAT. By Kaplan-Meier analysis, neither grading scheme correlated with overall survival in our cohort. However, the MD Anderson score was significantly correlated with both time to primary tumor recurrence (p=0.002) and time to distant recurrence (p=0.04); while the modified Ryan score did not.
Keywords: Pancreatic cancer; morphology; neoadjuvant therapy; tumor regression grade