Validation of the Anatomical and Biological Definitions of Borderline Resectable Pancreatic Cancer According to the 2017 International Consensus for Survival and Recurrence in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Upfront Surgery
Validation of the Anatomical and Biological Definitions of Borderline Resectable Pancreatic Cancer According to the 2017 International Consensus for Survival and Recurrence in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Upfront Surgery
复制标题
根据 2017 年接受前期手术的胰腺导管腺癌患者生存和复发国际共识，验证交界性可切除胰腺癌的解剖学和生物学定义
作者：
Boram Lee;Yoo;Meeyoung Kang;Yeshong Park;Eun;Y. Jo;Jun Suh Lee;H. Lee;J. Cho;Ho
国际共识标准（ICC）（2017）根据解剖学、生物学和条件方面重新定义了边缘性可切除胰腺导管腺癌（BR-PDAC）患者。然而，这些新标准尚未得到全面验证。本回顾性队列研究的目的是验证可切除(R)和BR-PDAC患者接受前期手术的肿瘤预后的BR-PDAC的解剖学和生物学定义。方法选取2004 ~ 2020年接受R-和BR-PDAC术前手术的患者404例。根据ICC分类：可切除(R) (n = 259)，解剖边缘（BR-A） （n = 43），生物学边缘（BR-B） （n = 81），解剖和生物边缘（BR-AB） （n = 21）。结果与R组和BR-B组相比，BR-A组和BR-AB组术后并发症发生率分别为16.5%和27.2% (P < 0.001)， R0切除率分别为85.7%和80.2% (P < 0.001)， R0切除率分别为65.1%和61.9% （P = 0.003）。与R组和BR-A组相比，BR-B组（32.1%）和BR-AB组（57.1%）的早期复发率（术后6个月内）较高（16.5%和25.6%比32.1%和57.1%,P < 0.001）， 3年无复发生存率明显较低（36.1%和20.7%比12.1%和7.8%,P < 0.001）。结论解剖学定义的BR-PDAC与较高的边缘阳性切除风险和术后并发症发生率相关，而生物学定义的BR-PDAC与较高的早期复发率和较低的生存率相关。因此，解剖学和生物学定义在预测预后和确定新辅助治疗的有效性方面是有用的。
Background The International Consensus Criteria (ICC) (2017) redefined patients with borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) according to anatomical, biological, and conditional aspects. However, these new criteria have not been validated comprehensively. The aim of this retrospective cohort study was to validate the anatomical and biological definitions of BR-PDAC for oncological outcomes in patients with resectable (R) and BR-PDAC undergoing upfront surgery. Methods A total of 404 patients who underwent upfront surgery for R- and BR-PDAC from 2004 to 2020 were included. The patients were classified according to the ICC as follows: resectable (R) ( n = 259), anatomical borderline (BR-A) ( n = 43), biological borderline (BR-B) ( n = 81), and anatomical and biologic borderline (BR-AB) ( n = 21). Results Compared with the R and BR-B groups, the BR-A and BR-AB groups had higher postoperative complication rates (16.5% and 27.2% vs 32.5% and 33.4%; P < 0.001) and significantly lower R0 resection rates (85.7% and 80.2% vs 65.1% and 61.9%; P = 0.003). In contrast, compared with the R and BR-A groups, the BR-B (32.1%) and BR-AB (57.1%) groups had higher early recurrence rates (within postoperative 6 months) (16.5% and 25.6% vs 32.1% and 57.1%; P < 0.001) and significantly lower 3-year recurrence-free survival rates (36.1% and 20.7% vs 12.1% and 7.8%; P < 0.001). Conclusion Anatomically defined BR-PDAC was associated with a higher risk of margin-positive resection and postoperative complication rates, while biologically defined BR-PDAC was associated with higher early recurrence rates and lower survival rates. Thus, the anatomical and biological definitions are useful in predicting the prognosis and determining the usefulness of neoadjuvant therapy.
影响因子：
45.3
作者：
Versteijne, Eva;Suker, Mustafa;van Tienhoven, Geertjan
通讯作者：
van Tienhoven, Geertjan