The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA.
Ann Surg Oncol. 2011 Nov;18(12):3493-9. doi: 10.1245/s10434-011-1745-9. Epub 2011 May 3.
Margin status is one of the strongest prognosticators after resection of pancreatic ductal adenocarcinoma (PDAC). The clinical significance of pancreatic intraepithelial neoplasia (PanIN) at a surgical margin has not been established.
A total of 208 patients who underwent R0 resection for PDAC between 2004 and 2008 were selected. Intraoperative frozen section slides containing the final pancreatic parenchymal transection margin were evaluated for presence or absence, number, and grade of PanINs. Data were compared to clinicopathologic factors, including patient survival.
PanIN lesions were present in margins in 107 of 208 patients (51.4%). Median number of PanINs per pancreatic resection margin was 1 (range, 1-11). A total of 72 patients had PanIN-1 (34.6%), 44 had PanIN-2 (21.1%), and 16 had PanIN-3 (7.2%) at their margin. Overall median survival was 17.9 (95% confidence interval, 14-21.9) months. Neither the presence nor absence of PanIN nor histological grade had any significant correlation with important clinicopathologic characteristics. There were no significant survival differences between patients with or without PanIN lesions at the resection margin or among patients with PanIN-3 (carcinoma in situ) versus lower PanIN grades. However, patients with R1 resection had a significantly worse outcome compared with patients without invasive cancer at a margin irrespective of the presence of PanIN (P=0.02).
The presence of PanINs at a resection margin does not affect survival in patients who undergo R0 resection for PDAC. These results have significant clinical implications for surgeons, because no additional resection seems to be indicated when intraoperative frozen sections reveal even high-grade PanIN lesions.
切缘状态是胰腺导管腺癌（PDAC）切除术后最强的预后因素之一。胰腺上皮内瘤变（PanIN）在手术切缘处的临床意义尚未确定。
选择 2004 年至 2008 年间接受 PDAC RO 切除的 208 例患者。评估包含最终胰腺实质横断切缘的术中冷冻切片标本中是否存在 PanIN 及其数量和分级。并将数据与临床病理因素（包括患者生存）进行比较。
在 208 例患者中有 107 例（51.4%）的切缘存在 PanIN 病变。每个胰腺切除切缘的 PanIN 中位数为 1（范围 1-11）。72 例患者有 PanIN-1（34.6%），44 例有 PanIN-2（21.1%），16 例有 PanIN-3（7.2%）。总体中位生存时间为 17.9（95%置信区间，14-21.9）个月。PanIN 的存在与否或组织学分级均与重要的临床病理特征无显著相关性。在切缘处有或无 PanIN 病变的患者之间以及 PanIN-3（原位癌）与较低的 PanIN 分级的患者之间无显著的生存差异。然而，与切缘处无浸润性癌的患者相比，R1 切除的患者无论是否存在 PanIN，其生存结局均显著更差（P=0.02）。
在接受 PDAC RO 切除的患者中，切缘处存在 PanIN 并不影响生存。这些结果对外科医生具有重要的临床意义，因为当术中冷冻切片显示甚至是高级别的 PanIN 病变时，似乎不需要额外的切除。
