Department of Surgery, Asahi General Hospital, Asahi, Chiba, Japan.
Department of Surgery, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan.
Ann Surg Oncol. 2023 Dec;30(13):8621-8630. doi: 10.1245/s10434-023-14219-3. Epub 2023 Sep 1.
Tumor size (TS) is a well-established prognostic factor of pancreatic ductal adenocarcinoma (PDAC). However, whether a uniform treatment strategy can be applied for all resectable PDACs (R-PDACs) and borderline resectable PDACs (BR-PDACs), regardless of TS, remains unclear. This study aimed to investigate the impact of preoperative TS on surgical outcomes of patients with R-PDACs and BR-PDACs.
Chart data from three institutions were reviewed to select patients who underwent pancreatectomy for R-PDACs and BR-PDACs between January 2006 and December 2020. The patients were divided into TS and TS groups according to a TS cutoff value determined for each of R- and BR-PDAC using the minimum P value approach for the risk of R1 resection.
TS of 35 mm and 24 mm was the best cutoff value in R-PDAC and BR-PDAC, respectively. The R1 rate was higher in the TS than TS group, in both R- (n = 35, 37% versus n = 294, 19%; P = 0.011) and BR-PDAC (n = 89, 37% versus n = 27, 15%; P = 0.030). Overall survival was significantly better in the TS than TS group in R-PDAC (38.2 versus 12.1 months; P < 0.001), but comparable between the two groups in BR-DPAC (21.2 versus 22.7 months; P = 0.363). Multivariate analysis revealed TS > 35 mm as an independent predictor of worse survival in patients with R-PDAC.
Larger TS was associated with a higher R1 rate and is a worse prognostic factor in patients with R-PDAC.
肿瘤大小（TS）是胰腺导管腺癌（PDAC）的一个既定的预后因素。然而，对于可切除 PDAC（R-PDAC）和交界可切除 PDAC（BR-PDAC），是否可以应用统一的治疗策略，而不论 TS 如何，目前仍不清楚。本研究旨在探讨术前 TS 对 R-PDAC 和 BR-PDAC 患者手术结果的影响。
回顾了三个机构的图表数据，以选择 2006 年 1 月至 2020 年 12 月期间接受胰腺切除术治疗 R-PDAC 和 BR-PDAC 的患者。根据最小 P 值方法确定的 R1 切除风险，将患者分为 TS 和 TS 组。
R-PDAC 和 BR-PDAC 的最佳 TS 截止值分别为 35mm 和 24mm。在 R-（n = 35，37%）和 BR-PDAC（n = 89，37%）中，TS 组的 R1 率均高于 TS 组，（n = 294，19%；P = 0.011）和（n = 27，15%；P = 0.030）。R-PDAC 中，TS 组的总生存率明显优于 TS 组（38.2 与 12.1 个月；P < 0.001），但 BR-DPAC 两组之间无差异（21.2 与 22.7 个月；P = 0.363）。多变量分析显示，TS > 35mm 是 R-PDAC 患者生存较差的独立预测因素。
较大的 TS 与更高的 R1 率相关，是 R-PDAC 患者预后较差的一个因素。
