The Revised R Status is an Independent Predictor of Postresection Survival in Pancreatic Cancer After Neoadjuvant Treatment.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
12 Apr 2023
12 Apr 2023
Historique:
entrez:
12
4
2023
pubmed:
13
4
2023
medline:
13
4
2023
Statut:
aheadofprint
Résumé
To investigate the oncological outcomes of patients with pancreatic ductal adenocarcinoma (PDAC) who had a R0 or R1 resection based on the revised R status (1 mm) after neoadjuvant therapy (NAT). The revised R status is an independent prognostic factor in upfront-resected PDAC; however, the significance of 1 mm margin clearance after NAT remains controversial. Patients undergoing pancreatectomy following NAT for PDAC were identified from two prospectively maintained databases. Clinicopathological and survival data were analyzed. The primary outcomes were overall survival (OS), recurrence-free survival (RFS), and pattern of recurrence in association with R0>1 mm and R1≤1 mm resections. Three hundred fifty-seven patients with PDAC were included after NAT and subsequent pancreatic resection. Two hundred eight patients (58.3%) received FOLFIRINOX, 41 patients (11.5%) gemcitabine-based regimens, and 299 individuals (83.8%) received additional radiotherapy. R0 resections were achieved in 272 patients (76.2%) and 85 patients (23.8%) had R1 resections. Median OS after R0 was 41.0 months, compared with 20.6 months after R1 resection (P=0.002) and even longer after additional adjuvant chemotherapy (R0 44.8 mo vs. R1 23.3 mo; P=0.0032). Median RFS in the R0 subgroup was 17.5 months versus 9.4 months in the R1 subgroup (P<0.0001). R status was confirmed as an independent predictor for OS (R1: HR 1.56, 95% CI 1.07-2.26) and RFS (R1: HR 1.52; 95% CI 1.14-2.0). In addition, R1 resections were significantly associated with local but not distant recurrence (P=0.0005). The revised R status is an independent predictor of postresection survival and local recurrence in PDAC after NAT. Achieving R0 resection with a margin of at least 1 mm should be a primary goal in the surgical treatment of PDAC after NAT.
Sections du résumé
OBJECTIVE
OBJECTIVE
To investigate the oncological outcomes of patients with pancreatic ductal adenocarcinoma (PDAC) who had a R0 or R1 resection based on the revised R status (1 mm) after neoadjuvant therapy (NAT).
BACKGROUND
BACKGROUND
The revised R status is an independent prognostic factor in upfront-resected PDAC; however, the significance of 1 mm margin clearance after NAT remains controversial.
METHODS
METHODS
Patients undergoing pancreatectomy following NAT for PDAC were identified from two prospectively maintained databases. Clinicopathological and survival data were analyzed. The primary outcomes were overall survival (OS), recurrence-free survival (RFS), and pattern of recurrence in association with R0>1 mm and R1≤1 mm resections.
RESULTS
RESULTS
Three hundred fifty-seven patients with PDAC were included after NAT and subsequent pancreatic resection. Two hundred eight patients (58.3%) received FOLFIRINOX, 41 patients (11.5%) gemcitabine-based regimens, and 299 individuals (83.8%) received additional radiotherapy. R0 resections were achieved in 272 patients (76.2%) and 85 patients (23.8%) had R1 resections. Median OS after R0 was 41.0 months, compared with 20.6 months after R1 resection (P=0.002) and even longer after additional adjuvant chemotherapy (R0 44.8 mo vs. R1 23.3 mo; P=0.0032). Median RFS in the R0 subgroup was 17.5 months versus 9.4 months in the R1 subgroup (P<0.0001). R status was confirmed as an independent predictor for OS (R1: HR 1.56, 95% CI 1.07-2.26) and RFS (R1: HR 1.52; 95% CI 1.14-2.0). In addition, R1 resections were significantly associated with local but not distant recurrence (P=0.0005).
CONCLUSION
CONCLUSIONS
The revised R status is an independent predictor of postresection survival and local recurrence in PDAC after NAT. Achieving R0 resection with a margin of at least 1 mm should be a primary goal in the surgical treatment of PDAC after NAT.
Identifiants
pubmed: 37042245
doi: 10.1097/SLA.0000000000005874
pii: 00000658-990000000-00426
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
Conflict of Interest Declaration: The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.