Department of Pathology, Odense University Hospital, Odense, Denmark; Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Odense Patient data Exploratory Network-OPEN, Odense University Hospital, Odense, Denmark.
Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Odense Patient data Exploratory Network-OPEN, Odense University Hospital, Odense, Denmark; Department of Surgery, Odense University Hospital, Odense, Denmark.
Pathol Res Pract. 2024 Feb;254:155077. doi: 10.1016/j.prp.2023.155077. Epub 2024 Jan 3.
The prognostic role of resection margin status following total (TP) and distal (DP) pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) is insufficiently evaluated. In Denmark, pancreatic surgery, including the postoperative pathological examination of the resection specimens, is confined to four centres, all reporting to the Danish Pancreatic Cancer Database (DPCD). In this Danish population-based nationwide study on TP and DP for PDAC from 2015-2019, based on data from DPCD, we evaluated whether there is a prognostically relevant minimum margin clearance definition and whether certain margins hold independent prognostic information.
Clinical and pathological data were retrieved from DPCD and supplemented by review of pathology reports and re-microscopy, if needed. One of the study pathologists performed all re-microscopy. The prognostic significance of margin status was evaluated by dichotomisation of the TP cohort (n = 101) and the DP cohort (n = 90) into involved and uninvolved groups, using different clearance definitions (0.5 - ≥3.0 mm).
Following TP, direct involvement of the superior mesenteric artery (SMA) margin had independent prognostic value. When using a clearance definition of ≥ 0.5 or ≥ 1.5 mm for SMA, median survival for R0 versus R1 was 19 (95% CI 14-26) versus 10 (95% CI 5-20) months (p = 0.010), and 21 (95% CI 15-30) versus 10 (95% CI 8-19) months (p = 0.011), respectively. Overall margin status was not of significant prognostic importance following neither DP nor TP.
In this Danish population-based nationwide study, SMA margin involvement was a significant isolated prognostic factor following TP, whereas combined assessment of all circumferential margins did not hold statistically significant prognostic information. Following DP, resection margin status did not affect survival.
在全胰切除术（TP）和远端胰腺切除术（DP）治疗胰腺导管腺癌（PDAC）中，切缘状态的预后作用评估不足。在丹麦，胰腺手术包括术后对切除标本的病理检查，仅局限于四个中心，这些中心都向丹麦胰腺癌症数据库（DPCD）报告。在这项基于 2015-2019 年 DPCD 数据的丹麦全国性、基于人群的 TP 和 DP 治疗 PDAC 的研究中，我们评估了是否存在具有预后相关性的最小切缘清除定义，以及某些切缘是否具有独立的预后信息。
从 DPCD 中检索临床和病理数据，并根据需要通过复习病理报告和重新显微镜检查进行补充。一位研究病理学家对所有重新进行显微镜检查。通过将 TP 队列（n=101）和 DP 队列（n=90）分为受累和未受累组，使用不同的清除定义（0.5-≥3.0mm），对切缘状态的预后意义进行了评估。
在 TP 后，肠系膜上动脉（SMA）切缘的直接受累具有独立的预后价值。当 SMA 的清除定义为≥0.5 或≥1.5mm 时，R0 与 R1 的中位生存期分别为 19（95%CI 14-26）与 10（95%CI 5-20）个月（p=0.010）和 21（95%CI 15-30）与 10（95%CI 8-19）个月（p=0.011）。在 DP 和 TP 后，整体切缘状态均无显著的预后意义。
在这项丹麦全国性、基于人群的研究中，SMA 切缘受累是 TP 后的一个显著孤立的预后因素，而所有环周切缘的综合评估没有统计学上显著的预后信息。在 DP 后，切缘状态并不影响生存。
