Padillo-Ruiz Javier, Garcia Carlos, Suarez Gonzalo, Blanco Gerardo, Muñoz-Bellvis Luis, Justo Iago, García-Domingo Maria I, Ausania Fabio, Muñoz-Forner Elena, Serrablo Alejandro, Martin Elena, Díez Luis, Cepeda Carmen, Marin Luis, Alamo Jose, Bernal Carmen, Pereira Sheila, Calero Francisco, Laga Imán, Paterna Sandra, Cugat Esteban, Fondevila Constantino, López-Guerra Diego, Gallego-Jiménez Inmaculada, Borrero-Martín Juan José, Gomez-Bravo Miguel Ángel, Tinoco Jose, Sabater Luis
Virgen del Rocío University Hospital, IBIS, Seville.
Badajoz University Hospital, University of Extremadura, Badajoz.
Int J Surg. 2024 Dec 1;110(12):7798-7805. doi: 10.1097/JS9.0000000000002153.
A positive surgical margin (R1 resection) is a relevant risk factor for local recurrence in patients with pancreatic ductal adenocarcinoma of the pancreas (PDAC). An intraoperative liquid biopsy (ILB) based on tumor cell mobilization could help to detect R1 resection intraoperatively.
To evaluate the potential role of the intraoperative circulating tumor cells (CTCs) and cluster mobilization on the R0/R1 detection.
Sixty-three patients with resectable PDAC of the head of the pancreas were prospective enrolled under the CETUPANC trial. Open pancreaticoduodenectomy (PD) was done in all patients. Intraoperative CTCs and clusters were determined during PD.
The overall rate of R1 resection was 34.9% (22/63 patients). Multivariate analysis showed that factors associated with R1 resection (AUC=0.920) were the presence of undifferentiated G3 tumor (P=0.017), microscopic vascular invasion (P=0.016), and the intraoperative increase of both free CTCs and clusters in portal vein determination from the beginning to the end of the surgery (P=0.002 and P=0.005, respectively). A specific logistic regression model, including delta end to baseline CTCs and cluster mobilization to achieve a combined cut-off to detect R1 detection was calculated (AUC=0.799). The obtained R1-index based on ILB had 84% of sensitivity and 68% of specificity to detect R1 resection.
The ILB based on the intraoperative mobilization of CTCs and clusters from the beginning to the end of the PD was a predictive factor to detect R1 resection in patients with PDAC.
切缘阳性（R1切除）是胰腺导管腺癌（PDAC）患者局部复发的一个相关危险因素。基于肿瘤细胞动员的术中液体活检（ILB）有助于在术中检测R1切除。
评估术中循环肿瘤细胞（CTC）和细胞簇动员在R0/R1检测中的潜在作用。
63例可切除的胰头PDAC患者前瞻性纳入CETUPANC试验。所有患者均行开放性胰十二指肠切除术（PD）。术中在PD期间测定CTC和细胞簇。
R1切除的总体发生率为34.9%（22/63例患者）。多因素分析显示，与R1切除相关的因素（AUC=0.920）为未分化G3肿瘤的存在（P=0.017）、微血管侵犯（P=0.016），以及手术开始至结束时门静脉测定中游离CTC和细胞簇的术中增加（分别为P=0.002和P=0.005）。计算了一个特定的逻辑回归模型，包括基线至终点CTC的变化量和细胞簇动员，以实现联合截断值来检测R1切除（AUC=0.799）。基于ILB获得的R1指数检测R1切除的敏感性为84%，特异性为68%。
基于PD全程中CTC和细胞簇术中动员的ILB是检测PDAC患者R1切除的一个预测因素。
