Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 18;16(3):e0248633.
doi: 10.1371/journal.pone.0248633. eCollection 2021.

Predictive factors for long-term survival after surgery for pancreatic ductal adenocarcinoma: Making a case for standardized reporting of the resection margin using certified cancer center data

Dirk Weyhe  1 , Dennis Obonyo  1 , Verena Nicole Uslar  1 , Ingo Stricker  2 , Andrea Tannapfel  2
Affiliations

Predictive factors for long-term survival after surgery for pancreatic ductal adenocarcinoma: Making a case for standardized reporting of the resection margin using certified cancer center data

Dirk Weyhe et al. PLoS One. .

Abstract

Factors for overall survival after pancreatic ductal adenocarcinoma (PDAC) seem to be nodal status, chemotherapy administration, UICC staging, and resection margin. However, there is no consensus on the definition for tumor free resection margin. Therefore, univariate OS as well as multivariate long-term survival using cancer center data was analyzed with regards to two different resection margin definitions. Ninety-five patients met inclusion criteria (pancreatic head PDAC, R0/R1, no 30 days mortality). OS was analyzed in univariate analysis with respect to R-status, CRM (circumferential resection margin; positive: ≤1mm; negative: >1mm), nodal status, and chemotherapy administration. Long-term survival >36 months was modelled using multivariate logistic regression instead of Cox regression because the distribution function of the dependent data violated the requirements for the application of this test. Significant differences in OS were found regarding the R status (Median OS and 95%CI for R0: 29.8 months, 22.3-37.4; R1: 15.9 months, 9.2-22.7; p = 0.005), nodal status (pN0 = 34.7, 10.4-59.0; pN1 = 17.1, 11.5-22.8; p = 0.003), and chemotherapy (with CTx: 26.7, 20.4-33.0; without CTx: 9.7, 5.2-14.1; p < .001). OS according to CRM status differed on a clinically relevant level by about 12 months (CRM positive: 17.2 months, 11.5-23.0; CRM negative: 29.8 months, 18.6-41.1; p = 0.126). A multivariate model containing chemotherapy, nodal status, and CRM explained long-term survival (p = 0.008; correct prediction >70%). Chemotherapy, nodal status and resection margin according to UICC R status are univariate factors for OS after PDAC. In contrast, long-term survival seems to depend on wider resection margins than those used in UICC R classification. Therefore, standardized histopathological reporting (including resection margin size) should be agreed upon.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow chart.
Fig 2
Fig 2. OS for CRM positive and CRM negative patients.
Fig 3
Fig 3. OS for deceased patients as a function of CRM.
Fig 4
Fig 4. OS for R1 and R0 patients.
Fig 5
Fig 5. OS für pN0 and pN1 patients.
Fig 6
Fig 6. OS for patients with and without CTx.
Fig 7
Fig 7. OS as a function of CTx, PN status, and CRM status.
See this image and copyright information in PMC

References

    1. Kayahara M, Nagakawa T, Ueno K, Ohta T, Takeda T, Miyazaki I. An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging. Cancer. 1993;72(7):2118–23. 10.1002/1097-0142(19931001)72:7<2118::aid-cncr2820720710>3.0.co;2-4 - DOI - PubMed
    1. Carpelan-Holmström M, Nordling S, Pukkala E, Sankila R, Lüttges J, Klöppel G, et al.. Does anyone survive pancreatic ductal adenocarcinoma? A nationwide study re-evaluating the data of the Finnish Cancer Registry. Gut. 2005;54(3):385–7. 10.1136/gut.2004.047191 - DOI - PMC - PubMed
    1. Raut CP, Tseng JF, Sun CC, Wang H, Wolff RA, Crane CH, et al.. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Annals of surgery. 2007;246(1):52. 10.1097/01.sla.0000259391.84304.2b - DOI - PMC - PubMed
    1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al.. Cancer statistics, 2008. CA: a cancer journal for clinicians. 2008;58(2):71–96. 10.3322/CA.2007.0010 - DOI - PubMed
    1. Alexakis N, Halloran C, Raraty M, Ghaneh P, Sutton R, Neoptolemos J. Current standards of surgery for pancreatic cancer. British Journal of Surgery. 2004;91(11):1410–27. 10.1002/bjs.4794 - DOI - PubMed

MeSH terms