J Medrano1, J Garnier1, J Ewald1, U Marchese1, M Gilabert2, S Launay2, F Poizat3, M Giovannini4, J R Delpero1, O Turrini5. 1. Departement of Surgery, Institut Paoli-Calmettes, Marseille, France. 2. Departement of Oncology, Institut Paoli-Calmettes, Marseille, France. 3. Departement of Pathology, Institut Paoli-Calmettes, Marseille, France. 4. Departement of Endoscopy, Institut Paoli-Calmettes, Marseille, France. 5. Departement of Surgery, Aix-Marseille University, Institut Paoli-Calmettes, CRCM, Marseille, France. Electronic address: turrinio@ipc.unicancer.fr.
Abstract
BACKGROUND/ OBJECTIVE: We evaluated the usefulness of the 2017 definition of borderline pancreatic ductal adenocarcinoma (BR-PDAC) in fit patients (performance status 0-1) based on anatomical (A) and biological dimensions (B). METHODS: From 2011 to 2018, 139 resected patients with BR-PDAC according to the 2017 definition were included: 18 patients underwent upfront pancreatectomy (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; BR-B group), and 121 received FOLFIRINOX (FX) induction chemotherapy and were divided into BR-A (CA 19-9 < 500 U/mL, no regional lymph node metastasis; n = 68) and BR-AB (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; n = 53) groups. RESULTS: The 3 groups were comparable according to patient characteristics (except for back pain (P < .01) and CA 19-9 (P < .01)), intraoperative data, and postoperative courses. BR-AB patients required more venous resections (P < .01). The 3 groups were comparable on pathologic findings, except that BR-B patients had more lymph node invasions (P = .02). Median overall survival (OS) of the 121 patients was 45 months. In multivariate analysis, venous resection (P = .039) and R1 resection (P = .012) were poorly linked with OS, whereas BR-A classification (P < .01) independently favored OS. Median survival times of BR-A, BR-AB, and BR-B groups were undetermined, 27 months, and 20 months (P < .001), respectively. CONCLUSIONS: The 2017 definition was relevant for sub-classifying patients with BR-PDAC. The anatomical dimension (BR-A) was a favorable prognostic factor, whereas the biological dimension (BR-AB and BR-B) poorly impacted survival.
BACKGROUND/ OBJECTIVE: We evaluated the usefulness of the 2017 definition of borderline pancreatic ductal adenocarcinoma (BR-PDAC) in fit patients (performance status 0-1) based on anatomical (A) and biological dimensions (B). METHODS: From 2011 to 2018, 139 resected patients with BR-PDAC according to the 2017 definition were included: 18 patients underwent upfront pancreatectomy (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; BR-B group), and 121 received FOLFIRINOX (FX) induction chemotherapy and were divided into BR-A (CA 19-9 < 500 U/mL, no regional lymph node metastasis; n = 68) and BR-AB (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; n = 53) groups. RESULTS: The 3 groups were comparable according to patient characteristics (except for back pain (P < .01) and CA 19-9 (P < .01)), intraoperative data, and postoperative courses. BR-AB patients required more venous resections (P < .01). The 3 groups were comparable on pathologic findings, except that BR-B patients had more lymph node invasions (P = .02). Median overall survival (OS) of the 121 patients was 45 months. In multivariate analysis, venous resection (P = .039) and R1 resection (P = .012) were poorly linked with OS, whereas BR-A classification (P < .01) independently favored OS. Median survival times of BR-A, BR-AB, and BR-B groups were undetermined, 27 months, and 20 months (P < .001), respectively. CONCLUSIONS: The 2017 definition was relevant for sub-classifying patients with BR-PDAC. The anatomical dimension (BR-A) was a favorable prognostic factor, whereas the biological dimension (BR-AB and BR-B) poorly impacted survival.
Authors: C Mattevi; J Garnier; U Marchese; J Ewald; M Gilabert; F Poizat; G Piana; J R Delpero; O Turrini Journal: BMC Surg Date: 2020-08-05 Impact factor: 2.102
Authors: Quisette P Janssen; Jacob L van Dam; Isabelle G Kivits; Marc G Besselink; Casper H J van Eijck; Marjolein Y V Homs; Joost J M E Nuyttens; Hongchao Qi; Hjalmar J van Santvoort; Alice C Wei; Roeland F de Wilde; Johanna W Wilmink; Geertjan van Tienhoven; Bas Groot Koerkamp Journal: Ann Surg Oncol Date: 2021-06-17 Impact factor: 5.344