Microscopic resection margin status in pancreatic ductal adenocarcinoma – A nationwide analysis
Menée à partir de données portant sur 595 patients atteints d'un adénocarcinome canalaire du pancréas traité par résection entre 2014 et 2016, cette étude évalue l'association entre le statut des marges de résection microscopique (taille des marges saines : supérieure ou égale à 1mm, inférieure à 1 mm ; envahissement des marges de résection) et la survie des patients
Introduction : First, this study aimed to assess the prognostic value of different definitions for resection margin status on disease-free survival (DFS) and overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC). Second, preoperative predictors of direct margin involvement were identified.
Materials and methods : This nationwide observational cohort study included all patients who underwent upfront PDAC resection (2014–2016), as registered in the prospective Dutch Pancreatic Cancer Audit. Patients were subdivided into three groups: R0 (
≥
1 mm margin clearance), R1 (<1 mm margin clearance) or R1 (direct margin involvement). Survival was compared using multivariable Cox regression analysis. Logistic regression with baseline variables was performed to identify preoperative predictors of R1 (direct).
Results: 595 patients with a median OS of 18 (IQR10-32) months were analysed. R0 (
≥
1 mm) was achieved in 277 patients (47%), R1 (<1 mm) in 146 patients (24%) and R1 (direct) in 172 patients (29%). R1 (direct) was associated with a worse OS, as compared with both R0 (
≥
1 mm) (hazard ratio (HR) 1.35 [95%confidence interval (CI) 1.08–1.70); P < 0.01) and R1 (<1 mm) (HR1.29 [95%CI 1.01–1.67]; P < 0.05). No OS difference was found between R0 (
≥
1 mm) and R1 (<1 mm) (HR1.05 [95%CI 0.82–1.34]; P = 0.71). Preoperative predictors associated with an increased risk of R1 (direct) included age, male sex, performance score 2–4, and venous or arterial tumour involvement.
Conclusion: Resection margin clearance of <1 mm, but without direct margin involvement, does not affect survival, as compared with a margin clearance of
≥
1 mm. Given that any vascular tumour involvement on preoperative imaging was associated with an increased risk of R1 (direct) resection with upfront surgery, neoadjuvant therapy might be considered in these patients.
European Journal of Surgical Oncology , résumé, 2019