Turrini O, Gilabert M, Ewald J, Moutardier V, Delpero J-R, Iovanna J-L
Department of Surgical Oncology, institut Paoli-Calmettes, 13009 Marseille, France; Inserm U1068, Parc scientifique de Luminy, université de la Méditerranée, 13009 Marseille, France.
Department of Medical Oncology, institut Paoli-Calmettes, 13009 Marseille, France; Inserm U1068, Parc scientifique de Luminy, université de la Méditerranée, 13009 Marseille, France.
J Visc Surg. 2017 Oct;154(5):329-333. doi: 10.1016/j.jviscsurg.2017.05.009. Epub 2017 Aug 23.
To assess the K-ras gene mutation in the histologically negative venous margin of a pancreaticoduodenectomy (PD) specimen and its impact on survival.
From 2007 to 2010, 22 patients underwent R0 PD for resecable pancreatic adenocarcinoma. All specimens were stained and the portal vein (PV) bed was identified by blue ink; a 2mm sample (including the blue ink) was cut from a microscopic free-tumor block. DNA was extracted and assessed by quantitative real time polymerase chain reaction to detect the K-ras gene mutation. Twelve specimens (55%) (kras+ group) were identified with a K-ras mutation in the venous margin resection, and 10 specimens (kras- group) did not have K-ras mutation detected in the venous margin resection.
The two groups were comparable. Overall 3years survival of patients of kras+ group versus patients of kras- group was 0 and 17% (P=0.03), respectively. Median survival time of patients of kras+ group versus patients of kras- group was 16months vs 25months (P=0.04; 95% confidence interval [1,11-1,88]), respectively.
Genetic evaluation of venous resection margin affirmed unrecognized disease with strong impact on survival in more than 50% of patients with histologically R0 resection.
评估胰十二指肠切除术（PD）标本组织学阴性切缘的K-ras基因突变情况及其对生存的影响。
2007年至2010年，22例患者因可切除性胰腺腺癌接受R0 PD手术。所有标本均进行染色，门静脉（PV）床用蓝色墨水标记；从显微镜下无肿瘤的组织块切取2mm样本（包括蓝色墨水标记部分）。提取DNA并通过定量实时聚合酶链反应评估以检测K-ras基因突变。12例标本（55%）（kras+组）在静脉切缘切除标本中检测到K-ras突变，10例标本（kras-组）在静脉切缘切除标本中未检测到K-ras突变。
两组具有可比性。kras+组患者与kras-组患者的3年总生存率分别为0和17%（P=0.03）。kras+组患者与kras-组患者的中位生存时间分别为16个月和25个月（P=0.04；95%置信区间[1.11-1.88]）。
静脉切缘的基因评估证实了在超过50%组织学R0切除的患者中存在未被识别的疾病，对生存有强烈影响。
