切缘状态对可切除、临界可切除及局部进展期胰腺癌患者复发和生存的影响。

Impact of resection margin status on recurrence and survival in patients with resectable, borderline resectable, and locally advanced pancreatic cancer.

作者信息

Rompen Ingmar F, Marchetti Alessio, Levine Jonah, Swett Benjamin, Galimberti Veronica, Han Jane, Riachi Mansour E, Habib Joseph R, Imam Rami, Kaplan Brian, Sacks Greg D, Cao Wenqing, Wolfgang Christopher L, Javed Ammar A, Hewitt D Brock

机构信息

Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: https://twitter.com/IngmarFRompen.

Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY; Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. Electronic address: https://twitter.com/alemarche055.

出版信息

Surgery. 2025 Apr;180:109114. doi: 10.1016/j.surg.2024.109114. Epub 2025 Jan 10.

DOI:10.1016/j.surg.2024.109114

PMID:39798179

Abstract

BACKGROUND

To improve outcomes for patients with pancreatic ductal adenocarcinoma, a complete resection is crucial. However, evidence regarding the impact of microscopically positive surgical margins (R1) on recurrence is conflicting due to varying definitions and limited populations of patients with borderline-resectable and locally advanced pancreatic cancer. Therefore, we aimed to determine the impact of the resection margin status on recurrence and survival in patients with pancreatic ductal adenocarcinoma stratified by local tumor stage.

METHODS

We performed a retrospective cohort study on patients with nonmetastatic pancreatic ductal adenocarcinoma undergoing pancreatectomy at a high-volume academic center (2012-2022). R1 was subclassified into microscopic invasion of the margin (R1 direct) or carcinoma present within 1 mm but not directly involving the margin (R1 <1 mm). Overall survival and time to recurrence were assessed by log-rank test and multivariable Cox regression.

RESULTS

Of 472 included patients, 154 (33%) had an R1 resection. Of those 50 (32%) had R1 <1 mm and 104 (68%) R1 direct. The most commonly involved margin was the uncinate (41%) followed by the pancreatic neck (16%) and vascular margins (9%). Overall, a stepwise shortening of time to recurrence and overall survival was observed with an increasing degree of margin involvement (median time to recurrence: R0 39.3 months, R1 <1 mm 16.0 months, and R1 direct 13.4 months, all comparisons P < .05). Multivariable analyses confirmed the independent prognostic value of R1 direct across all surgical stages.

CONCLUSION

The resection margin status portends an independent prognostic value. Moreover, this association persists in patients with borderline-resectable and locally advanced pancreatic cancer. Increasing the R0-resection rate is the most important potentially influenceable prognostic factor for improving surgery-related outcomes.

摘要

背景

为改善胰腺导管腺癌患者的预后，完整切除至关重要。然而，由于定义不同以及可切除边缘和局部晚期胰腺癌患者群体有限，关于显微镜下切缘阳性（R1）对复发影响的证据存在冲突。因此，我们旨在确定切缘状态对按局部肿瘤分期分层的胰腺导管腺癌患者复发和生存的影响。

方法

我们对在一家大型学术中心接受胰腺切除术的非转移性胰腺导管腺癌患者进行了一项回顾性队列研究（2012 - 2022年）。R1被细分为切缘的显微镜下侵犯（R1直接侵犯）或距切缘1毫米内存在癌但未直接累及切缘（R1 <1毫米）。通过对数秩检验和多变量Cox回归评估总生存期和复发时间。

结果

在纳入的472例患者中，154例（33%）为R1切除。其中，50例（32%）为R1 <1毫米，104例（68%）为R1直接侵犯。最常受累的切缘是钩突（41%），其次是胰颈（16%）和血管切缘（9%）。总体而言，随着切缘受累程度增加，观察到复发时间和总生存期逐步缩短（中位复发时间：R0为39.3个月，R1 <1毫米为16.0个月，R1直接侵犯为13.4个月，所有比较P <.05）。多变量分析证实R1直接侵犯在所有手术分期中均具有独立的预后价值。