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. 2021 Sep;25(9):2307-2316.
doi: 10.1007/s11605-020-04870-6. Epub 2020 Dec 2.

Impact of Resection Margin Status in Patients with Pancreatic Cancer: a National Cohort Study

Christof Kaltenmeier  1 , Ibrahim Nassour  1 , Richard S Hoehn  1 , Sidrah Khan  1 , Alison Althans  1 , David A Geller  1 , Alessandro Paniccia  1 , Amer Zureikat  1 , Samer Tohme  2
Affiliations

Impact of Resection Margin Status in Patients with Pancreatic Cancer: a National Cohort Study

Christof Kaltenmeier et al. J Gastrointest Surg. 2021 Sep.

Abstract

Aim: To assess the predictors and influence of resection margins and the role of neoadjuvant and adjuvant therapy on survival for a national cohort of patients with resected pancreatic cancer.

Methods: Using the National Cancer Data Base between 2004 and 2016, 56,532 patients were identified who underwent surgical resection for pancreatic adenocarcinoma. Univariate and multivariate models were employed to identify factors predicting R0/R1 resection and assess the impact on survival.

Results: In total, 48,367 (85.6%) patients were found to have negative margins (R0) compared to 8165 (14.4%) who had microscopic residual tumor (R1). Factors predicting positive margin on univariate analysis included male gender, Medicare, advanced stage, moderately or poorly differentiated tumor, lymphovascular invasion, and tumors > 2 cm. Factors predicting R0 resection included receipt of neoadjuvant therapy and treatment at an Academic/Research Center. Following adjustment for other factors, margin status remained an independent predictor for overall survival (HR: 1.24; 95% CI 1.22-1.27, p < 0.001) (1-, 3-, and 5-year overall survival rates (R0: 77%, 37%, and 25% vs R1: 62%, 19%, and 10%).

Conclusions: A positive margin predicts a poorer survival than R0 resections regardless of stage and receipt of adjuvant therapy. Several modifiable factors significantly predict the likelihood of R0 resection including neoadjuvant treatment and treatment at Academic/Research Programs. Knowledge about these factors can help guide patient management by offering neoadjuvant treatment modalities at Academic as well as Community hospitals.

Keywords: Margin status; pancreatic cancer; predictors of R1 resection; survival.

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Conflict of interest statement

Conflict of interest statement All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The University of Pittsburgh holds a Physician-Scientist Institutional Award from the Burroughs Wellcome Fund: C.K. S.K.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves demonstrating 5-year survival for pancreatic adenocarcinoma comparing patients with R0 vs R1 resection margin with/without adjuvant treatment
Fig. 2
Fig. 2
Kaplan–Meier survival graphs by stage. Kaplan–Meier curves demonstrating 5-year survival for pancreatic adenocarcinoma comparing patients with R0 vs R1 resection margin at every stage
See this image and copyright information in PMC

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