Matsumoto Michinori, Tsunematsu Masashi, Furukawa Kenei, Haruki Koichiro, Shirai Yoshihiro, Onda Shinji, Uwagawa Tadashi, Gocho Takeshi, Yanagaki Mitsuru, Ikegami Toru
Department of Surgery, The Jikei University School of Medicine, Japan.
Department of Surgery, The Jikei University School of Medicine, Japan.
Surg Oncol. 2025 Oct;62:102270. doi: 10.1016/j.suronc.2025.102270. Epub 2025 Jul 17.
s: This study aimed to identify recurrence and prognostic factors in patients with resectable pancreatic cancer (RPC) that may define biological borderline resectable pancreatic cancer (BRPC).
This retrospective study included 162 patients with R/BRPC who underwent upfront surgery. Univariate and multivariate analyses were performed to assess the relationship between preoperative factors and disease-free survival (DFS) and overall survival (OS) for RPC. The cutoff value for the coefficient of variation of apparent diffusion coefficient (CV) on preoperative magnetic resonance imaging was determined using receiver operating characteristic curve analysis. Surgical outcomes of patients with RPC were stratified by a score, with each independent prognostic factor assigned 1 point. The outcomes of R/BRPC patients were compared according to the score.
Of the patients, 145 had RPC, and 17 had BRPC. In RPC patients, serum CA19-9 >500 U/mL (p = 0.03) and CV ≥ 0.1 (p = 0.003) were independent recurrence factors, while serum CA19-9 >500 U/mL (p = 0.03), superior mesenteric vein/portal vein contact <180° (p = 0.03), and CV ≥ 0.1 (p < 0.001) were independent prognostic factors. RPC patients with a score of 0 had significantly better prognoses than those with scores of 1 or 2-3, and BRPC patients (median DFS: 35.0, 9.8, 9.0, and 7.0 months; median OS: 80.7, 26.5, 16.8, and 17.6 months, respectively). No significant difference in prognosis was found between BRPC patients and RPC patients with scores of 1 or 2-3.
Preoperative CV in RPC may be a new recurrence and prognostic factor defining biological BRPC.
本研究旨在确定可切除胰腺癌（RPC）患者中可能定义生物学上临界可切除胰腺癌（BRPC）的复发和预后因素。
这项回顾性研究纳入了162例行初次手术的R/BRPC患者。进行单因素和多因素分析以评估术前因素与RPC的无病生存期（DFS）和总生存期（OS）之间的关系。使用受试者工作特征曲线分析确定术前磁共振成像上表观扩散系数（CV）变异系数的临界值。RPC患者的手术结果按评分分层，每个独立预后因素赋予1分。根据评分比较R/BRPC患者的结果。
患者中，145例为RPC，17例为BRPC。在RPC患者中，血清CA19-9>500 U/mL（p = 0.03）和CV≥0.1（p = 0.003）是独立的复发因素，而血清CA19-9>500 U/mL（p = 0.03）、肠系膜上静脉/门静脉接触<180°（p = 0.03）和CV≥0.1（p < 0.001）是独立的预后因素。评分为0的RPC患者的预后明显优于评分为1或2 - 3的患者以及BRPC患者（中位DFS：分别为35.0、9.8、9.0和7.0个月；中位OS：分别为80.7、26.5、16.8和17.6个月）。BRPC患者与评分为1或2 - 3的RPC患者之间在预后方面未发现显著差异。
RPC患者术前的CV可能是定义生物学BRPC的新的复发和预后因素。
