Impact of Margin Status on Survival in Patients with Pancreatic Ductal Adenocarcinoma Receiving Neoadjuvant Chemotherapy
| Autor: | Christopher L. Wolfgang, Michael J. Wright, Daniel Delitto, William R. Burns, Richard A. Burkhart, John L. Cameron, Ding Ding, Ryan K. Schmocker, Kelly J. Lafaro, Jin He |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Surgical margin FOLFIRINOX medicine.medical_treatment Leucovorin 030230 surgery Irinotecan Gastroenterology Disease-Free Survival Pancreaticoduodenectomy 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Adjuvant therapy Humans Prospective Studies Pancreas Aged Neoplasm Staging Retrospective Studies business.industry Hazard ratio Margins of Excision Middle Aged Neoadjuvant Therapy Oxaliplatin Pancreatic Neoplasms Radiation therapy Chemotherapy Adjuvant 030220 oncology & carcinogenesis Pancreatectomy Female Surgery CA19-9 Fluorouracil Neoplasm Recurrence Local business Carcinoma Pancreatic Ductal Follow-Up Studies |
| Zdroj: | Journal of the American College of Surgeons. 232:405-413 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/j.jamcollsurg.2020.11.018 |
| Popis: | Background Historically, a positive margin after pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) was associated with decreased survival. In an era when neoadjuvant chemotherapy (NAC) is being used frequently, the prognostic significance of margin status is unclear. Study Design Patients with localized PDAC who received NAC and underwent pancreatectomy from 2011 to 2018 were identified from a single-institution database. Patients with fewer than 2 months of NAC, R2 resection, or fewer than 90 days of follow-up were excluded. A positive margin included tumors within 1 mm of the surgical margin. Results Four hundred and sixty-eight patients met inclusion criteria. Median age was 65 years and 53% were female. Preoperative clinical staging demonstrated that most had locally advanced (n = 222 [47%]) or borderline resectable (n = 172 [37%]) disease. Median follow-up was 18.5 months (interquartile range 10.6 to 30.0 months). Median duration of NAC was 119 days (interquartile range 87 to 168 days). FOLFIRINOX was first-line therapy for 67%, and 73% received neoadjuvant radiotherapy. Most underwent pancreaticoduodenectomy (69%). Forty percent were node-positive and 80% had an R0 resection. Fifty-six percent received at least 1 cycle of adjuvant therapy. Median overall survival and recurrence-free survival were 22.0 months (95% CI, 19.4 to 25.1 months) and 11.0 months (95% CI, 10.0 to 12.1 months). On multivariate analysis, margin status was not a significant predictor of overall survival or recurrence-free survival. Factors associated with overall survival included clinical stage, duration of NAC, nodal status, histopathologic treatment response score, and receipt of adjuvant chemotherapy. Conclusions Microscopic margin positivity is not associated with recurrence and survival in localized PDAC patients resected after treatment with NAC. Aggressive surgical extirpation in high-volume centers should be considered in selected patients after extensive NAC. |
| Databáze: | OpenAIRE |
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