The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma
The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma
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DOI：
10.1097/sla.0000000000002557
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发表时间：
2019-03-01
影响因子：
9
通讯作者：
Neoptolemos, John P.
中科院分区：
文献类型：
--
作者：
Ghaneh, Paula;Kleeff, Jorg;Neoptolemos, John P.
目的和背景：胰腺癌切除术后经常观察到局部和远处疾病复发，但需要更好地了解切除边缘评估以帮助定制治疗。方法：进行分析以评估临床特征和切缘受累之间的关系，以及个体切缘受累对复发部位和总体复发的影响。结果：有1151例患者，其中505例（43.9%）进行了RI切除术。总生存期的中位数和95%置信区间（CI）为24.9（22.9-27.2）个月，646人切缘阴性R 0>1 mm者占56.1%，切缘阴性R 0>1 mm者占25.4（21.6 30.4）个月（12.7%）患者RI = 1，最大肿瘤大小，和RI-直接后切除边缘均与总体生存率和无复发生存率的降低独立显著相关。竞争风险分析显示，总体R1-直接阳性切缘状态、阳性淋巴结状态。WHO的性能状态1，和R1直接阳性上级肠系膜/内侧缘切除状态均显着相关的局部recruitment.Conclusions：RI直接切除与胰腺癌切除术后的总体和无复发生存率显着降低。切缘受累也与局部复发风险增加相关。
Objective and Background: Local and distant disease recurrence are frequently observed following pancreatic cancer resection, but an improved understanding of resection margin assessment is required to aid tailored therapies.Methods: Analyses were carried out to assess the association between clinical characteristics and margin involvement as well as the effects of individual margin involvement on site of recurrence and overall and recurrence-free survival using individual patient data from the European Study Group for Pancreatic Cancer (ESPAC)-3 randomized controlled trial.Results: There were 1151 patients, of whom 505 (43.9%) had an RI resection. The median and 95% confidence interval (CI) overall survival was 24.9 (22.9-27.2) months for 646 (56.1%) patients with resection margin negative R0 >1 mm) tumors, 25.4 (21.6 30.4) months for 146 (12.7%) patients with RI = 1, maximum tumor size, and RI-direct posterior resection margin were all independently significantly associated with reduced overall and recurrence-free survival. Competing risks analysis showed that overall R1-direct positive resection margin status, positive lymph node status. WHO performance status 1, and R1-direct positive superior mesenteric/medial margin resection status were all significantly associated with local recurrence.Conclusions: RI-direct resections were associated with significantly reduced overall and recurrence-free survival following pancreatic cancer resection. Resection margin involvement was also associated with an increased risk for local recurrence.