Clinical significance of revised microscopic positive resection margin status in ductal adenocarcinoma of pancreatic head

다국어 초록 (Multilingual Abstract)

Purpose: Recent studies have suggested microscopic positive resection margin should be revised according to the presence of tumor cells within 1mm of the margin surface in resected specimens of pancreatic cancer. However, the clinical meaning of this revised margin status for R1 resection margin was not fully clarified.
Methods: From July 2012 to December 2014, the medical records of 194 consecutive patients who underwent pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head were analyzed retrospectively. They were divided into 3 groups on margin status; revised microscopic negative margin (rR0) – tumor exists more than 1 mm from surgical margin, revised microscopic positive margin (rR1) – tumor present within less than 1 mm from surgical margin, classic microscopic positive margin (cR1) – tumor is exposed to surgical margin.
Results: There were 76 rR0 (39.2%), 100 rR1 (51.5%), and 18 cR1 (9.3%). There was significant difference in disease-free survival rates between cR1 vs. rR1 (8.4 months vs. 24.0 months, P = 0.013). Margin status correlated with local recurrence rate (17.1% in rR0, 26.0% in rR1, and 44.4% in cR1, P = 0.048). There is significant difference in recurrence at tumor bed (11.8% in rR0 vs. 23.0 in rR1, P = 0.050). Of rR1, adjuvant treatment was found to be an independent risk factor for local recurrence (hazard ratio, 0.297; 95% confidence interval, 0.127–0.693, P = 0.005).
Conclusion: Revised R1 resection margin (rR1) affects recurrence at the tumor bed. Adjuvant treatment significantly reduced local recurrence of rR1. Accordingly, adjuvant chemoradiation for rR1 group should be taken into account.

참고문헌 (Reference)

1 Verbeke CS, "Tumour growth is more dispersed in pancreatic head cancers than in rectal cancer : implications for resection margin assessment" 59 : 1111-1121, 2011

2 Jamieson NB, "The prognostic influence of resection margin clearance following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma" 17 : 511-521, 2013

3 Sobin LH, "TNM classification of malignant tumours" Wiley & Sons 2009

4 Sperti C, "Survival after resection for ductal adenocarcinoma of the pancreas" 83 : 625-631, 1996

5 The Royal College of Pathologists, "Standards and datasets for reporting cancers. Minimum dataset for the histopathological reporting of pancreatic, ampulla of vater and bile duct carcinoma" Royal College of Pathologists 2002

6 Gebauer F, "Resection margin clearance in pancreatic cancer after implementation of the Leeds Pathology Protocol(LEEPP) : clinically relevant or just academic" 39 : 493-499, 2015

7 Sohn TA, "Resected adenocarcinoma of the pancreas-616 patients : results, outcomes, and prognostic indicators" 4 : 567-579, 2000

8 Verbeke CS, "Redefining the R1 resection in pancreatic cancer" 93 : 1232-1237, 2006

9 Jamieson NB, "Positive mobilization margins alone do not influence survival following pancreatico-duodenectomy for pancreatic ductal adenocarcinoma" 251 : 1003-1010, 2010

10 Hishinuma S, "Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings" 10 : 511-518, 2006

11 Delpero JR, "Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens" 16 : 20-33, 2014

12 Yeo CJ, "Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients" 221 : 721-731, 1995

13 Konstantinidis IT, "Pancreatic ductal adenocarcinoma : is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a"true"R0 resection" 257 : 731-736, 2013

14 Hartwig W, "Pancreatic cancer surgery in the new millennium : better prediction of outcome" 254 : 311-319, 2011

15 Strobel O, "Pancreatic cancer surgery : the new R-status counts" 265 : 565-573, 2017

16 Merkow RP, "National assessment of margin status as a quality indicator after pancreatic cancer surgery" 21 : 1067-1074, 2014

17 Esposito I, "Most pancreatic cancer resections are R1 resections" 15 : 1651-1660, 2008

18 Chandrasegaram MD, "Metaanalysis of radical resection rates and margin assessment in pancreatic cancer" 102 : 1459-1472, 2015

19 Sugiura T, "Margin status, recurrence pattern, and prognosis after resection of pancreatic cancer" 154 : 1078-1086, 2013

20 Chang DK, "Margin clearance and outcome in resected pancreatic cancer" 27 : 2855-2862, 2009

21 Bassi C, "Influence of surgical resection and post-operative complications on survival following adjuvant treatment for pancreatic cancer in the ESPAC-1 randomized controlled trial" 22 : 353-363, 2005

22 Butturini G, "Influence of resection margins and treatment on survival in patients with pancreatic cancer : meta-analysis of randomized controlled trials" 143 : 75-83, 2008

23 Menon KV, "Impact of margin status on survival following pancreatoduodenectomy for cancer: the Leeds Pathology Protocol (LEEPP)" 11 : 18-24, 2009

24 Campbell F, "Classification of R1 resections for pancreatic cancer : the prognostic relevance of tumour involvement within 1 mm of a resection margin" 55 : 277-283, 2009

25 Bockhorn M, "Borderline resectable pancreatic cancer : a consensus statement by the International Study Group of Pancreatic Surgery(ISGPS)" 155 : 977-988, 2014

26 Neoptolemos JP, "Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection : a randomized controlled trial" 304 : 1073-1081, 2010

27 Winter JM, "1423 pancreaticoduodenectomies for pancreatic cancer : a single-institution experience" 10 : 1199-1210, 2006