Impact of Resection Margin Status in Patients with Pancreatic Cancer: a National Cohort Study
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ORIGINAL ARTICLE
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 1 Received: 22 June 2020 / Accepted: 6 November 2020 # 2020 The Society for Surgery of the Alimentary Tract
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 . survival . predictors of R1 resection . pancreatic cancer
Introduction In 2020, it is estimated that 57,600 Americans will be diagnosed with pancreatic cancer and more than 47,050 will die from the disease.1 Pancreatic cancer is now the 3rd leading cause of cancer-related deaths in the USA surpassing breast cancer.2 Curative resection is crucial for survival of patients with pancreatic adenocarcinoma (PDAC); however, only 20 to 30% of patients with pancreatic cancer have resectable disease at time of diagnosis.3 Long-term outcomes remain poor, even after resection, with an approximate survival rate of 37% for localized and 12% for regional disease.4 The long-term * Samer Tohme [email protected] 1
Department of Surgery, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore, 7 South, Pittsburgh, PA 15213-2582, USA
prognosis of patients undergoing surgery is determined by both pathologic and molecular characteristics of the tumor. Pathologic prognostic factors include stage, grade, size, and
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