근치적절제술을 시행한 췌장암환자의 예후인자로서 Flow Cytometry를 이용한 DNA Ploidy 검사의 의의

Abstract

Background/Aims: Only about 5 l0% of all the patients with pancreatic carcinoma that under- went radical resection survive for more than five years. Various factors related to the prognosis arc presently known, such as size, location, stage, multicentricity, cell type, histologic grading, mitotic activity, type of surgery, intraoperative irradiation, performance status, sex, etc. Recently DNA analysis using flow cytometry has widely been used to evaluate the prognostic factors in various malignancies, and there appears to be a relationship between DNA aneuploid and decreased survi- val. However the results are still controversial. Thus we conducted this study to evaluate the prognostic effect of DNA ploidy and synthetic phase fraction in patients with pancreatic cancer who underwent radical operation. Methods: Flow cytometric DNA analysis was performed using formalin fixed paraffin-embedded specimens of 14 cases of pancreatic carcinoma that underwent radical resection. In addition, clinicopathological review was done to determine the usefulness of this technique in predicting biologic behavior and prognosis. Results: Aneuploidy was noted in 6 cases(4'2.9/c) and diploidy in 8 cases(57.1%). The S-phase fraction(SPF) in aneuploid tumor(23.7 /n) was significantly higher than that in diploid tumor(9.5%). The median survival was 32.9 months and l5.7 months in diploid and aneuploid tumor respectively, and 44.3 months and 20.1 months in S-phase fraction below and above median value(l 1.0%) respectively. Aneuploidy and higher S-phase fraction were frequently encountered in cases with recurrence within 24 months after operation than in cases without recurrence during the entire follow-up period[mean 48(9- l20) months). Comparing various parameters related to the recurrence, higher rate of recurrence was noted in case.I with larger tumor size, advanced T or N stages, poor histologic grading, aneuploidy and higher S-phase fraction. Conclusion: These findings suggest that flow cytometric DNA analysis may be helpful in predicting the recurrence and in selecting patients with resectable pancreatic carcinoma who will benefit from operation.