Ghotbi Jacob, Farnes Ingvild, Kleive Dyre, Verbeke Caroline, Epe Aart Issa, Fosby Bjarte, Line Pål-Dag, Labori Knut Jørgen
Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Ann Surg Oncol. 2025 Jun 3. doi: 10.1245/s10434-025-17527-y.
This study aims to provide a detailed understanding of resectability and prognosis within anatomical subgroups of borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) on the basis of established classification systems.
Patients with BRPC/LAPC, defined by National Comprehensive Cancer Network (NCCN) criteria, were prospectively included from 2018 to 2020. BRPC was subcategorized by vascular involvement and LAPC by the Louisville (Lv) classification system, and both cohorts were reclassified according to the Dutch (DPCG) criteria. NCCN-defined primary resectable pancreatic cancer (PC) cases that met DPCG-BRPC criteria were included in the analysis.
In total, 228 patients (96 NCCN-BRPC, 92 NCCN-LAPC, and 40 reclassified from NNCN primary resectable PC to DPCG-BRPC) were included. NCCN-BRPC exhibiting both venous and arterial involvement had a lower resection rate (odds ratio (OR) 0.22, p = 0.038). Isolated vein involvement and baseline cancer antigen (CA)19-9 levels < 500 kU/L predicted resectability (OR 5.99, p = 0.005) and survival (hazard ratio (HR) 0.47, p = 0.024). DPCG-BRPC demonstrated higher resectability rates (67.4% versus 46.9%, p = 0.004) and fewer vascular resections (37% versus 58%, p = 0.031) compared with NCCN-BRPC. While the NCCN only predicted resectability, DPCG also predicted survival. No patients with Lv type IIIc2-4 (nonreconstructable invasion of the portomesenteric vein combined with arterial involvement) underwent resection, and this subgroup had worse survival (HR 2.08, p = 0.021).
Variations within established classification systems for BRPC/LAPC impact prediction of survival and resectability. A more detailed understanding of the anatomical subgroups in BRPC and LAPC, alongside CA19-9 levels, could enhance patient stratification regarding tumor resectability and neoadjuvant strategies.
本研究旨在基于既定的分类系统，详细了解交界可切除胰腺癌（BRPC）和局部晚期胰腺癌（LAPC）各解剖亚组的可切除性及预后情况。
前瞻性纳入2018年至2020年期间符合美国国立综合癌症网络（NCCN）标准的BRPC/LAPC患者。BRPC根据血管受累情况进行亚分类，LAPC根据路易斯维尔（Lv）分类系统进行分类，且两个队列均根据荷兰（DPCG）标准重新分类。分析纳入符合DPCG-BRPC标准的NCCN定义的原发性可切除胰腺癌（PC）病例。
共纳入228例患者（96例NCCN-BRPC、92例NCCN-LAPC以及40例从NNCN原发性可切除PC重新分类为DPCG-BRPC的患者）。同时存在静脉和动脉受累的NCCN-BRPC患者切除率较低（比值比（OR）0.22，p = 0.038）。孤立性静脉受累以及基线癌抗原（CA）19-9水平<500 kU/L可预测可切除性（OR 5.99，p = 0.005）和生存情况（风险比（HR）0.47，p = 0.024）。与NCCN-BRPC相比，DPCG-BRPC显示出更高的可切除率（67.4%对46.9%，p = 0.004）和更少的血管切除术（37%对58%，p = 0.031）。NCCN仅能预测可切除性，而DPCG还能预测生存情况。没有Lv IIIc2-4型（门静脉肠系膜静脉不可重建性侵犯合并动脉受累）的患者接受手术切除，且该亚组患者生存情况更差（HR 2. .08，p = 0.021）。
BRPC/LAPC既定分类系统内的差异会影响生存和可切除性的预测。更详细地了解BRPC和LAPC的解剖亚组以及CA19-9水平，可改善患者在肿瘤可切除性和新辅助治疗策略方面的分层。
