Abstract / Summary
Abstract Background Alterations in pancreatic innervation are characteristic of pancreatic ductal adenocarcinoma (PDAC) and are closely associated with poor prognosis. However, existing research has primarily focused on perineural invasion into intra-pancreatic nerves, with less attention given to structural alterations in extra-pancreatic nerves. This study aimed to investigate non-invasive changes in extra-pancreatic nerves across different diseases and analyze their correlation with prognosis in PDAC patients. Methods In this single-center prospective study, data from patients who underwent pancreatoduodenectomy between April 2019 and December 2019 were collected. Extra-pancreatic nerves were sampled at the junction where the gastroduodenal artery (GDA) and the common bile duct (CBD) enter the pancreatic head. Results A total of 92 pancreatoduodenectomy specimens were collected. Based on pathological findings, patients were divided into three groups: 54 in the PDAC group (Group 1), 26 in the non-PDAC malignant group (Group 2), and 12 in the benign pancreatic lesion group (Group 3). Nerve density in Group 1 was significantly higher than in Groups 2 and 3 at both the GDA (vs. Group 2, P = 0.002; vs. Group 3, P = 0.0003) and CBD (vs. Group 2, P = 0.04; vs. Group 3, P = 0.0009). Among the 53 PDAC patients included in the survival analysis, 41 (77.4%) died due to tumor progression. While patients with higher nerve density at the GDA showed a trend toward longer disease-specific survival (DSS), the difference did not reach statistical significance (24.0 months vs. 12.0 months, P = 0.13). Multivariate Cox analysis indicated that only poor differentiation was an independent risk factor affecting DSS in PDAC patients. Conclusions Extra-pancreatic nerves in PDAC patients demonstrate significantly increased density compared to other pancreatic lesions. A trend toward longer DSS was observed in PDAC patients with higher nerve density at the GDA site, although the difference was not statistically significant. Clinical trial Not applicable as this study does not meet the criteria for a clinical trial.