Matthaei Hanno, Hong Seung-Mo, Mayo Skye C, Dal Molin Marco, Olino Kelly, Venkat Raghunandan, Goggins Michael, Herman Joseph M, Edil Barish H, Wolfgang Christopher L, Cameron John L, Schulick Richard D, Maitra Anirban, Hruban Ralph H
The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University, Baltimore, MD, USA.
Indian J Surg Oncol. 2011 Mar;2(1):9-15. doi: 10.1007/s13193-011-0073-7. Epub 2011 Jun 30.
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。手术切缘处胰腺上皮内瘤变（PanIN）的临床意义尚未明确。
选取2004年至2008年间接受PDAC R0切除的208例患者。对包含最终胰腺实质横断切缘的术中冰冻切片进行评估，以确定是否存在PanIN、其数量及分级。将数据与临床病理因素进行比较，包括患者生存率。
208例患者中有107例（51.4%）切缘存在PanIN病变。每个胰腺切除切缘的PanIN中位数为1（范围为1至11）。共有72例患者切缘为PanIN-1（34.6%），44例为PanIN-2（21.1%），16例为PanIN-3（7.2%）。总体中位生存期为17.9个月（95%置信区间为14至21.9个月）。PanIN的有无及组织学分级与重要的临床病理特征均无显著相关性。切除切缘有或无PanIN病变的患者之间，以及PanIN-3（原位癌）患者与较低PanIN分级患者之间，生存率均无显著差异。然而，与切缘无浸润癌的患者相比，R1切除的患者无论切缘是否存在PanIN，预后均显著较差（P = 0.02）。
PDAC行R0切除的患者，切除切缘存在PanIN不影响生存。这些结果对外科医生具有重要临床意义,因为术中冰冻切片显示即使是高级别PanIN病变时，似乎也无需进行额外切除。
