Influence of the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer on clinical performance

Figure 1 Study participants. This flowchart explains how the final sample size was arrived at and which patients were included. Ninety-one patients with pancreatic cancer underwent radical surgery. Nine patients were treated with chemotherapy or chemoradiotherapy preoperatively and were therefore excluded. The remaining 82 patients were divided into 2 groups. One group consisted of patients who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) before the operation (FNA+ group; n = 54), and the other group included patients who did not undergo EUS-FNA before the operation (FNA- group; n = 28). The decision to use preoperative EUS-FNA was made by a surgeon. NAC: Neoadjuvant chemotherapy or chemoradiotherapy; EUS-FNA: Endoscopic ultrasound-guided fine-needle aspiration.

Figure 2 Kaplan-Meier curves for relapse-free survival in pancreatic cancer patients. Kaplan-Meier curves for relapse-free survival in patients who underwent resection for pancreatic cancer. The solid line indicates the Kaplan-Meyer curve for the FNA+ group and the dotted line represents that for the FNA- group. The median relapse-free survival time of the FNA+ and FNA- groups was 742 and 265 d, respectively (Log-rank test; P < 0.05). FNA+: The group of patients who underwent endoscopic ultrasound-guided fine-needle aspiration before surgery; FNA-: The group of patients who did not undergo endoscopic ultrasound-guided fine-needle aspiration before surgery.

Figure 3 Kaplan-Meier curves for overall survival in pancreatic cancer patients. Kaplan-Meier curves for overall survival in patients who underwent resection for pancreatic cancer. The solid line indicates the Kaplan-Meyer curve for the FNA+ group and the dotted line represents that for the FNA- group. The median survival time of the FNA+ and FNA- groups was 1042 and 557 d, respectively (Log-rank test; P < 0.05). FNA+: The group of patients who underwent endoscopic ultrasound-guided fine-needle aspiration before surgery; FNA-: The group of patients who did not undergo endoscopic ultrasound-guided fine-needle aspiration before surgery.

Figure 4 Kaplan-Meier curves for relapse-free survival and overall survival in patients who received adjuvant chemotherapy. A: Kaplan-Meier curves for relapse-free survival in patients who underwent resection for pancreatic cancer and who received adjuvant chemotherapy. The solid line indicates the Kaplan-Meyer curve for the FNA+ group and the dotted line represents that for the FNA- group. The median relapse-free survival time of the FNA+ and FNA- groups was 596 and 332 d, respectively (Log-rank test; P = 0.30); B: Kaplan-Meier curves for overall survival in patients who underwent resection for pancreatic cancer and who received adjuvant chemotherapy. The solid line indicates the Kaplan-Meyer curve for the FNA+ group and the dotted line represents that for the FNA- group. The median overall survival time of the FNA+ and FNA- groups was 1042 and 636 d, respectively (Log-rank test; P < 0.05). FNA+: The group of patients who underwent endoscopic ultrasound-guided fine-needle aspiration before surgery; FNA-: The group of patients who did not undergo endoscopic ultrasound-guided fine-needle aspiration before surgery.

Figure 5 Kaplan-Meier curves for relapse-free survival and overall survival in patients who did not receive adjuvant chemotherapy. A: Kaplan-Meier curves for relapse-free survival in patients who underwent resection for pancreatic cancer without adjuvant chemotherapy. The solid line indicates the Kaplan-Meyer curve for the FNA+ group and the dotted line represents that for the FNA- group. The median relapse-free survival time of the FNA+ and FNA- groups was 852 and 158 d, respectively (Log-rank test; P = 0.04); B: Kaplan-Meier curves for overall survival in patients who underwent resection for pancreatic cancer without adjuvant chemotherapy. The solid line indicates the Kaplan-Meyer curve for the FNA+ group and the dotted line represents that for the FNA- group. The median overall survival time of the FNA+ and FNA- groups was 829 and 400 d, respectively (Log-rank test; P = 0.08). FNA+: The group of patients who underwent endoscopic ultrasound-guided fine-needle aspiration before surgery; FNA-: The group of patients who did not undergo endoscopic ultrasound-guided fine-needle aspiration before surgery.