Detailed Abstract
[Poster Oral - HBP Malignant]
[E-008] Impact Of Cut-Surface Margin Status On Survival In Pancreatic Cancer: A Comparative Study Of Upfront Surgery And Neoadjuvant Chemotherapy
Yeonsu KIM1 , Changmoo KANG*1
1 Department Of Surgery, 연세대학교 세브란스병원, REPUBLIC OF KOREA
Background : Pancreatic cancer is highly aggressive with a poor prognosis. Surgical resection, often combined with neoadjuvant chemotherapy, is a primary treatment approach. This study compares survival outcomes of different surgical procedures and assesses the impact of cut-surface margin status on overall survival (OS) and disease-free survival (DFS) in both upfront surgery and neoadjuvant chemotherapy settings.
Methods : Patients who underwent surgery for pancreatic cancer at Severance Hospital from January 2015 to December 2021 were included. The study population included patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD), pancreaticoduodenectomy (PD), or total pancreatectomy (TP). The patients were divided into two groups: upfront surgery and neoadjuvant chemotherapy. Within each group, patients were classified based on margin status into R0 (negative margins) and R1 (positive margins). Survival outcomes were compared between the groups. Cox proportional hazards model was used for statistical analysis to identify independent prognostic factors.
Results : In the upfront surgery group, 165 patients had R0 resection and 27 had R1 resection. Median OS was 38 months for R0 and 51 months for R1 (p = 0.869), while median DFS was 14 months for R0 and 12 months for R1 (p = 0.759). In the neoadjuvant chemotherapy group, 121 patients had R0 resection and 26 had R1 resection. Median OS for R0 was 54 months, significantly higher than 16 months for R1 (p < 0.001). Median DFS was 14 months for R0 and 7 months for R1 (p = 0.001). Additionally, Cox proportional hazards analysis revealed that R status was a significant independent predictor of survival in the neoadjuvant chemotherapy group, with a hazard ratio (HR) of 1.985 (p = 0.008).
Conclusions : Cut-surface margin status is a crucial prognostic factor for pancreatic cancer, especially in patients receiving neoadjuvant chemotherapy. While it did not significantly impact survival in the upfront surgery group, it was vital in predicting outcomes in the neoadjuvant group. Additionally, the significant impact of R1 status in the neoadjuvant group suggests the presence of micro-metastatic disease, a characteristic feature of pancreatic cancer. These findings highlight the importance of considering margin status in treatment planning for pancreatic cancer, with R status being a significant independent prognostic factor in the neoadjuvant setting.
Methods : Patients who underwent surgery for pancreatic cancer at Severance Hospital from January 2015 to December 2021 were included. The study population included patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD), pancreaticoduodenectomy (PD), or total pancreatectomy (TP). The patients were divided into two groups: upfront surgery and neoadjuvant chemotherapy. Within each group, patients were classified based on margin status into R0 (negative margins) and R1 (positive margins). Survival outcomes were compared between the groups. Cox proportional hazards model was used for statistical analysis to identify independent prognostic factors.
Results : In the upfront surgery group, 165 patients had R0 resection and 27 had R1 resection. Median OS was 38 months for R0 and 51 months for R1 (p = 0.869), while median DFS was 14 months for R0 and 12 months for R1 (p = 0.759). In the neoadjuvant chemotherapy group, 121 patients had R0 resection and 26 had R1 resection. Median OS for R0 was 54 months, significantly higher than 16 months for R1 (p < 0.001). Median DFS was 14 months for R0 and 7 months for R1 (p = 0.001). Additionally, Cox proportional hazards analysis revealed that R status was a significant independent predictor of survival in the neoadjuvant chemotherapy group, with a hazard ratio (HR) of 1.985 (p = 0.008).
Conclusions : Cut-surface margin status is a crucial prognostic factor for pancreatic cancer, especially in patients receiving neoadjuvant chemotherapy. While it did not significantly impact survival in the upfront surgery group, it was vital in predicting outcomes in the neoadjuvant group. Additionally, the significant impact of R1 status in the neoadjuvant group suggests the presence of micro-metastatic disease, a characteristic feature of pancreatic cancer. These findings highlight the importance of considering margin status in treatment planning for pancreatic cancer, with R status being a significant independent prognostic factor in the neoadjuvant setting.
SESSION
Poster Oral
E-Session 09/06 ALL DAY