The impact of resection margin distance on survival and recurrence in pancreatic ductal adenocarcinoma in a retrospective cohort analysis
The prognostic effect of resection margin status following pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) remains controversial, even with the implementation of standardized pathological assessment. We therefore investigated the impact of resection margin (RM) status and RM distan...
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| creator | Obonyo, Dennis Uslar, Verena Nicole Münding, Johanna Weyhe, Dirk Tannapfel, Andrea |
| description | The prognostic effect of resection margin status following pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) remains controversial, even with the implementation of standardized pathological assessment. We therefore investigated the impact of resection margin (RM) status and RM distance in curative resected PDAC on overall survival (OS), disease-free survival (DFS) and recurrence.
108 patients were retrieved from a prospectively maintained database of a certified pancreatic cancer center. Distribution and relationships between circumferential resection margin (CRM) involvement (CRM≤1mm; CRM>1mm; CRM≥2mm) and their prognostic impact on OS and DFS were assessed using Kaplan-Meier statistics and the Log-Rank test. Multivariate logistic regression was used explain the development of a recurrence 12 months after surgery.
63 out of 108 patients had medial RM and 32 posterior RM involvement. There was no significant difference in OS and DFS between CRM≤1mm and CRM>1mm resections. Clearance at the medial margin of ≥2mm had an impact on OS and DFS, (RM≥2mm vs. RM1mm) seems not sufficient. Future studies should include more patients to stratify for potential confounders we could not account for.
This study was registered with the German Clinical Trials Registry (reference number DRKS0017425). |
| doi_str_mv | 10.1371/journal.pone.0281921 |
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108 patients were retrieved from a prospectively maintained database of a certified pancreatic cancer center. Distribution and relationships between circumferential resection margin (CRM) involvement (CRM≤1mm; CRM>1mm; CRM≥2mm) and their prognostic impact on OS and DFS were assessed using Kaplan-Meier statistics and the Log-Rank test. Multivariate logistic regression was used explain the development of a recurrence 12 months after surgery.
63 out of 108 patients had medial RM and 32 posterior RM involvement. There was no significant difference in OS and DFS between CRM≤1mm and CRM>1mm resections. Clearance at the medial margin of ≥2mm had an impact on OS and DFS, (RM≥2mm vs. RM<2mm: median OS 29.8 vs 16.8 months, median DFS 19.6 vs. 10.3 months). Multivariate analysis demonstrated that age, medial RM ≥2mm, lymph node status and chemotherapy were prognostic factors for OS and DFS. Posterior RM had no influence on OS or DFS.
Not all RM seem to have the same impact on OS and DFS, and a clearance of 1mm for definition of a negative RM (i.e. CRM>1mm) seems not sufficient. Future studies should include more patients to stratify for potential confounders we could not account for.
This study was registered with the German Clinical Trials Registry (reference number DRKS0017425).</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0281921</identifier><identifier>PMID: 36800357</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adenocarcinoma ; Analysis ; Bile ducts ; Cancer ; Cancer therapies ; Carcinoma, Pancreatic Ductal - pathology ; Care and treatment ; Chemotherapy ; Clinical trials ; Cohort analysis ; Customer relationship management software ; Diagnosis ; Hospitals ; Humans ; Lymph nodes ; Lymphatic system ; Margins of Excision ; Medical research ; Medicine and Health Sciences ; Medicine, Experimental ; Multivariate analysis ; Neoplasm Recurrence, Local ; Pancreatectomy ; Pancreatic cancer ; Pancreatic Neoplasms ; Pancreatic Neoplasms - pathology ; Pancreaticoduodenectomy ; Patient outcomes ; Patients ; Prognosis ; Rank tests ; Relapse ; Retrospective Studies ; Statistical analysis ; Surgery ; Survival ; Systemic diseases ; Tomography ; Veins & arteries</subject><ispartof>PloS one, 2023-02, Vol.18 (2), p.e0281921-e0281921</ispartof><rights>Copyright: © 2023 Obonyo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Obonyo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Obonyo et al 2023 Obonyo et al</rights><rights>2023 Obonyo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c641t-248b939d881de0530fc78612a254d4565fc883b949db62737ec6f6997a7959583</cites><orcidid>0000-0003-3252-2076</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9937496/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9937496/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23865,27923,27924,53790,53792,79371,79372</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36800357$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Finkelmeier, Fabian</contributor><creatorcontrib>Obonyo, Dennis</creatorcontrib><creatorcontrib>Uslar, Verena Nicole</creatorcontrib><creatorcontrib>Münding, Johanna</creatorcontrib><creatorcontrib>Weyhe, Dirk</creatorcontrib><creatorcontrib>Tannapfel, Andrea</creatorcontrib><title>The impact of resection margin distance on survival and recurrence in pancreatic ductal adenocarcinoma in a retrospective cohort analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The prognostic effect of resection margin status following pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) remains controversial, even with the implementation of standardized pathological assessment. We therefore investigated the impact of resection margin (RM) status and RM distance in curative resected PDAC on overall survival (OS), disease-free survival (DFS) and recurrence.
108 patients were retrieved from a prospectively maintained database of a certified pancreatic cancer center. Distribution and relationships between circumferential resection margin (CRM) involvement (CRM≤1mm; CRM>1mm; CRM≥2mm) and their prognostic impact on OS and DFS were assessed using Kaplan-Meier statistics and the Log-Rank test. Multivariate logistic regression was used explain the development of a recurrence 12 months after surgery.
63 out of 108 patients had medial RM and 32 posterior RM involvement. There was no significant difference in OS and DFS between CRM≤1mm and CRM>1mm resections. Clearance at the medial margin of ≥2mm had an impact on OS and DFS, (RM≥2mm vs. RM<2mm: median OS 29.8 vs 16.8 months, median DFS 19.6 vs. 10.3 months). Multivariate analysis demonstrated that age, medial RM ≥2mm, lymph node status and chemotherapy were prognostic factors for OS and DFS. Posterior RM had no influence on OS or DFS.
Not all RM seem to have the same impact on OS and DFS, and a clearance of 1mm for definition of a negative RM (i.e. CRM>1mm) seems not sufficient. Future studies should include more patients to stratify for potential confounders we could not account for.
This study was registered with the German Clinical Trials Registry (reference number DRKS0017425).</description><subject>Adenocarcinoma</subject><subject>Analysis</subject><subject>Bile ducts</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Carcinoma, Pancreatic Ductal - pathology</subject><subject>Care and treatment</subject><subject>Chemotherapy</subject><subject>Clinical trials</subject><subject>Cohort analysis</subject><subject>Customer relationship management software</subject><subject>Diagnosis</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Lymph nodes</subject><subject>Lymphatic system</subject><subject>Margins of Excision</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Medicine, Experimental</subject><subject>Multivariate analysis</subject><subject>Neoplasm Recurrence, Local</subject><subject>Pancreatectomy</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreaticoduodenectomy</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Rank tests</subject><subject>Relapse</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Survival</subject><subject>Systemic diseases</subject><subject>Tomography</subject><subject>Veins & arteries</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9-K1DAUxoso7rr6BqIFQfRixiZpk-ZGWBb_DCws6OptOJOkM1napCbp4D6Cb206012mshfSi5aT3_lOztdzsuwlKpaIMPThxg3eQrvsndXLAteIY_QoO0Wc4AXFBXl89H2SPQvhpigqUlP6NDshtC4KUrHT7M_1Vuem60HG3DW510HLaJzNO_AbY3NlQgQrdZ5CYfA7s4M2B6sSKQfv9XiUsD4xXkM0MleDjCOjtHUSvDTWdTAykHKid6EfK-x0Lt3W-ZjEoL0NJjzPnjTQBv1iep9lPz5_ur74uri8-rK6OL9cSFqiuMBlveaEq7pGSqeGikaymiIMuCpVWdGqkXVN1rzkak0xI0xL2lDOGTBe8aomZ9nrg27fuiAmF4PAjLG9KzgRqwOhHNyI3pvkxa1wYMQ-4PxGgE-ttloApkTzQpVYNSUtClBcVUA5lBgx0CxpfZyqDetOK6lt9NDOROcn1mzFxu0E54SVnCaBd5OAd78GHaLoTJC6bcFqN-zvXWOGMKoS-uYf9OHuJmoDqQFjG5fqylFUnCe7aIlZSRK1fIBKj9KdkWnkGpPis4T3s4TERP07bmAIQay-f_t_9urnnH17xG41tHEbXDuMQxrmYHkAZZqx4HVzbzIqxLgxd26IcWPEtDEp7dXxD7pPulsR8hcl1BIU</recordid><startdate>20230217</startdate><enddate>20230217</enddate><creator>Obonyo, Dennis</creator><creator>Uslar, Verena Nicole</creator><creator>Münding, Johanna</creator><creator>Weyhe, Dirk</creator><creator>Tannapfel, Andrea</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-3252-2076</orcidid></search><sort><creationdate>20230217</creationdate><title>The impact of resection margin distance on survival and recurrence in pancreatic ductal adenocarcinoma in a retrospective cohort analysis</title><author>Obonyo, Dennis ; Uslar, Verena Nicole ; Münding, Johanna ; Weyhe, Dirk ; Tannapfel, Andrea</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c641t-248b939d881de0530fc78612a254d4565fc883b949db62737ec6f6997a7959583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adenocarcinoma</topic><topic>Analysis</topic><topic>Bile ducts</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Carcinoma, Pancreatic Ductal - pathology</topic><topic>Care and treatment</topic><topic>Chemotherapy</topic><topic>Clinical trials</topic><topic>Cohort analysis</topic><topic>Customer relationship management software</topic><topic>Diagnosis</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Lymph nodes</topic><topic>Lymphatic system</topic><topic>Margins of Excision</topic><topic>Medical research</topic><topic>Medicine and Health Sciences</topic><topic>Medicine, Experimental</topic><topic>Multivariate analysis</topic><topic>Neoplasm Recurrence, Local</topic><topic>Pancreatectomy</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreaticoduodenectomy</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Rank tests</topic><topic>Relapse</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Survival</topic><topic>Systemic diseases</topic><topic>Tomography</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Obonyo, Dennis</creatorcontrib><creatorcontrib>Uslar, Verena Nicole</creatorcontrib><creatorcontrib>Münding, Johanna</creatorcontrib><creatorcontrib>Weyhe, Dirk</creatorcontrib><creatorcontrib>Tannapfel, Andrea</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Obonyo, Dennis</au><au>Uslar, Verena Nicole</au><au>Münding, Johanna</au><au>Weyhe, Dirk</au><au>Tannapfel, Andrea</au><au>Finkelmeier, Fabian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of resection margin distance on survival and recurrence in pancreatic ductal adenocarcinoma in a retrospective cohort analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-02-17</date><risdate>2023</risdate><volume>18</volume><issue>2</issue><spage>e0281921</spage><epage>e0281921</epage><pages>e0281921-e0281921</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The prognostic effect of resection margin status following pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) remains controversial, even with the implementation of standardized pathological assessment. We therefore investigated the impact of resection margin (RM) status and RM distance in curative resected PDAC on overall survival (OS), disease-free survival (DFS) and recurrence.
108 patients were retrieved from a prospectively maintained database of a certified pancreatic cancer center. Distribution and relationships between circumferential resection margin (CRM) involvement (CRM≤1mm; CRM>1mm; CRM≥2mm) and their prognostic impact on OS and DFS were assessed using Kaplan-Meier statistics and the Log-Rank test. Multivariate logistic regression was used explain the development of a recurrence 12 months after surgery.
63 out of 108 patients had medial RM and 32 posterior RM involvement. There was no significant difference in OS and DFS between CRM≤1mm and CRM>1mm resections. Clearance at the medial margin of ≥2mm had an impact on OS and DFS, (RM≥2mm vs. RM<2mm: median OS 29.8 vs 16.8 months, median DFS 19.6 vs. 10.3 months). Multivariate analysis demonstrated that age, medial RM ≥2mm, lymph node status and chemotherapy were prognostic factors for OS and DFS. Posterior RM had no influence on OS or DFS.
Not all RM seem to have the same impact on OS and DFS, and a clearance of 1mm for definition of a negative RM (i.e. CRM>1mm) seems not sufficient. Future studies should include more patients to stratify for potential confounders we could not account for.
This study was registered with the German Clinical Trials Registry (reference number DRKS0017425).</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>36800357</pmid><doi>10.1371/journal.pone.0281921</doi><tpages>e0281921</tpages><orcidid>https://orcid.org/0000-0003-3252-2076</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adenocarcinoma Analysis Bile ducts Cancer Cancer therapies Carcinoma, Pancreatic Ductal - pathology Care and treatment Chemotherapy Clinical trials Cohort analysis Customer relationship management software Diagnosis Hospitals Humans Lymph nodes Lymphatic system Margins of Excision Medical research Medicine and Health Sciences Medicine, Experimental Multivariate analysis Neoplasm Recurrence, Local Pancreatectomy Pancreatic cancer Pancreatic Neoplasms Pancreatic Neoplasms - pathology Pancreaticoduodenectomy Patient outcomes Patients Prognosis Rank tests Relapse Retrospective Studies Statistical analysis Surgery Survival Systemic diseases Tomography Veins & arteries |
| title | The impact of resection margin distance on survival and recurrence in pancreatic ductal adenocarcinoma in a retrospective cohort analysis |
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