Superior Mesenteric Artery Margin of Posttherapy Pancreaticoduodenectomy and Prognosis in Patients With Pancreatic Ductal Adenocarcinoma
Negative-margin resection is crucial to favorable prognosis in patients with pancreatic ductal adenocarcinoma. However, the definition of a negative superior mesenteric artery margin (SMAM) varies. The College of American Pathologists defines positive SMAM as the presence of tumor cells at the margi...
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| creator | Liu, Li Katz, Matthew H Lee, Sun M Fischer, Laurice K Prakash, Laura Parker, Nathan Wang, Hua Varadhachary, Gauri R Wolff, Robert A Lee, Jeffrey E Pisters, Peter W Maitra, Anirban Fleming, Jason B Estrella, Jeannelyn Rashid, Asif Wang, Huamin |
| description | Negative-margin resection is crucial to favorable prognosis in patients with pancreatic ductal adenocarcinoma. However, the definition of a negative superior mesenteric artery margin (SMAM) varies. The College of American Pathologists defines positive SMAM as the presence of tumor cells at the margin, whereas the European protocol is based on a 1 mm clearance. In this study, we examined the prognostic significance of the SMAM distance in 411 consecutive pancreatic ductal adenocarcinoma patients who completed neoadjuvant therapy and pancreaticoduodenectomy. Per College of American Pathologists criteria, 32 (7.8%) had positive margins, and 379 (92.2%) had negative margins. Among margin-negative group, SMAM was ≤1, 1.0 to 5.0, and >5.0 mm in 66, 145, and 168 patients, respectively. There was no difference in either disease-free survival (DFS) or overall survival (OS) between the positive-margin group and SMAM≤1 mm (P>0.05). However, patients with SMAM 1.0 to 5.0 mm had better OS than those with positive margins or SMAM≤1 mm (P=0.02). Patients with SMAM>5.0 mm had better DFS and OS than those with SMAM 1.0 to 5.0 mm and those with positive margins or SMAM≤1 mm (P |
| doi_str_mv | 10.1097/PAS.0000000000000491 |
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However, the definition of a negative superior mesenteric artery margin (SMAM) varies. The College of American Pathologists defines positive SMAM as the presence of tumor cells at the margin, whereas the European protocol is based on a 1 mm clearance. In this study, we examined the prognostic significance of the SMAM distance in 411 consecutive pancreatic ductal adenocarcinoma patients who completed neoadjuvant therapy and pancreaticoduodenectomy. Per College of American Pathologists criteria, 32 (7.8%) had positive margins, and 379 (92.2%) had negative margins. Among margin-negative group, SMAM was ≤1, 1.0 to 5.0, and >5.0 mm in 66, 145, and 168 patients, respectively. There was no difference in either disease-free survival (DFS) or overall survival (OS) between the positive-margin group and SMAM≤1 mm (P>0.05). However, patients with SMAM 1.0 to 5.0 mm had better OS than those with positive margins or SMAM≤1 mm (P=0.02). Patients with SMAM>5.0 mm had better DFS and OS than those with SMAM 1.0 to 5.0 mm and those with positive margins or SMAM≤1 mm (P<0.01). By multivariate analysis, the SMAM distance, tumor differentiation, lymph node metastasis, and histopathologic tumor response grade were independent prognostic factors for both DFS and OS. SMAM distance correlated with lower ypT and AJCC stages, smaller tumor size, better histopathologic tumor response grade, fewer lymph node metastases, and recurrences (P<0.05). Thus our results strongly support use of SMAM>1 mm for R0 resection in posttherapy pancreaticoduodenectomy specimens.</description><identifier>ISSN: 0147-5185</identifier><identifier>EISSN: 1532-0979</identifier><identifier>DOI: 10.1097/PAS.0000000000000491</identifier><identifier>PMID: 26200098</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biopsy ; Carcinoma, Pancreatic Ductal - mortality ; Carcinoma, Pancreatic Ductal - secondary ; Carcinoma, Pancreatic Ductal - surgery ; Chi-Square Distribution ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Mesenteric Artery, Superior - pathology ; Mesenteric Artery, Superior - surgery ; Middle Aged ; Multivariate Analysis ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neoplasm, Residual ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy - adverse effects ; Pancreaticoduodenectomy - methods ; Pancreaticoduodenectomy - mortality ; Predictive Value of Tests ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Tumor Burden</subject><ispartof>The American journal of surgical pathology, 2015-10, Vol.39 (10), p.1395-1403</ispartof><rights>Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3561-511854e7198d84c6f479e6195896fe9a088688ed2f679fd53ebae9fdb0b04cc13</citedby><cites>FETCH-LOGICAL-c3561-511854e7198d84c6f479e6195896fe9a088688ed2f679fd53ebae9fdb0b04cc13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26200098$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Li</creatorcontrib><creatorcontrib>Katz, Matthew H</creatorcontrib><creatorcontrib>Lee, Sun M</creatorcontrib><creatorcontrib>Fischer, Laurice K</creatorcontrib><creatorcontrib>Prakash, Laura</creatorcontrib><creatorcontrib>Parker, Nathan</creatorcontrib><creatorcontrib>Wang, Hua</creatorcontrib><creatorcontrib>Varadhachary, Gauri R</creatorcontrib><creatorcontrib>Wolff, Robert A</creatorcontrib><creatorcontrib>Lee, Jeffrey E</creatorcontrib><creatorcontrib>Pisters, Peter W</creatorcontrib><creatorcontrib>Maitra, Anirban</creatorcontrib><creatorcontrib>Fleming, Jason B</creatorcontrib><creatorcontrib>Estrella, Jeannelyn</creatorcontrib><creatorcontrib>Rashid, Asif</creatorcontrib><creatorcontrib>Wang, Huamin</creatorcontrib><title>Superior Mesenteric Artery Margin of Posttherapy Pancreaticoduodenectomy and Prognosis in Patients With Pancreatic Ductal Adenocarcinoma</title><title>The American journal of surgical pathology</title><addtitle>Am J Surg Pathol</addtitle><description>Negative-margin resection is crucial to favorable prognosis in patients with pancreatic ductal adenocarcinoma. However, the definition of a negative superior mesenteric artery margin (SMAM) varies. The College of American Pathologists defines positive SMAM as the presence of tumor cells at the margin, whereas the European protocol is based on a 1 mm clearance. In this study, we examined the prognostic significance of the SMAM distance in 411 consecutive pancreatic ductal adenocarcinoma patients who completed neoadjuvant therapy and pancreaticoduodenectomy. Per College of American Pathologists criteria, 32 (7.8%) had positive margins, and 379 (92.2%) had negative margins. Among margin-negative group, SMAM was ≤1, 1.0 to 5.0, and >5.0 mm in 66, 145, and 168 patients, respectively. There was no difference in either disease-free survival (DFS) or overall survival (OS) between the positive-margin group and SMAM≤1 mm (P>0.05). However, patients with SMAM 1.0 to 5.0 mm had better OS than those with positive margins or SMAM≤1 mm (P=0.02). Patients with SMAM>5.0 mm had better DFS and OS than those with SMAM 1.0 to 5.0 mm and those with positive margins or SMAM≤1 mm (P<0.01). By multivariate analysis, the SMAM distance, tumor differentiation, lymph node metastasis, and histopathologic tumor response grade were independent prognostic factors for both DFS and OS. SMAM distance correlated with lower ypT and AJCC stages, smaller tumor size, better histopathologic tumor response grade, fewer lymph node metastases, and recurrences (P<0.05). Thus our results strongly support use of SMAM>1 mm for R0 resection in posttherapy pancreaticoduodenectomy specimens.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biopsy</subject><subject>Carcinoma, Pancreatic Ductal - mortality</subject><subject>Carcinoma, Pancreatic Ductal - secondary</subject><subject>Carcinoma, Pancreatic Ductal - surgery</subject><subject>Chi-Square Distribution</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Mesenteric Artery, Superior - pathology</subject><subject>Mesenteric Artery, Superior - surgery</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Recurrence, Local</subject><subject>Neoplasm Staging</subject><subject>Neoplasm, Residual</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Pancreaticoduodenectomy - mortality</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Tumor Burden</subject><issn>0147-5185</issn><issn>1532-0979</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kd1KAzEQhYMotlbfQCSX3mxNtvuTXJb6CxUXqni5pNnZdnV3U5MspW_gYzvSKsULA2EGcr4TZg4h55wNOZPpVTaeDdn-iSQ_IH0ej8IA3-Uh6TMepUHMRdwjJ869McZDwcNj0guTEAEp-uRz1q3AVsbSR3DQeuw1HVusG_qo7KJqqSlpZpz3S7BqtaGZarUF5Sttis4U0IL2ptlQ1RY0s2bRGlc5ilyGGnR09LXyyz2MXnfaq5qOkTVaWV21plGn5KhUtYOzXR2Ql9ub58l9MH26e5iMp4EexQnHaXCcCFIuRSEinZRRKiHhMhYyKUEqJkQiBBRhmaSyLOIRzBVgM2dzFmnNRwNyufVdWfPRgfN5UzkNda1aMJ3Lecp5HMV4URptpdoa5yyU-cpWjbKbnLP8O4McM8j_ZoDYxe6Hbt5A8Qv9LB0FYitYmxoX7d7rbg02X4Kq_fJ_7y__ypWe</recordid><startdate>201510</startdate><enddate>201510</enddate><creator>Liu, Li</creator><creator>Katz, Matthew H</creator><creator>Lee, Sun M</creator><creator>Fischer, Laurice K</creator><creator>Prakash, Laura</creator><creator>Parker, Nathan</creator><creator>Wang, Hua</creator><creator>Varadhachary, Gauri R</creator><creator>Wolff, Robert A</creator><creator>Lee, Jeffrey E</creator><creator>Pisters, Peter W</creator><creator>Maitra, Anirban</creator><creator>Fleming, Jason B</creator><creator>Estrella, Jeannelyn</creator><creator>Rashid, Asif</creator><creator>Wang, Huamin</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</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>7X8</scope></search><sort><creationdate>201510</creationdate><title>Superior Mesenteric Artery Margin of Posttherapy Pancreaticoduodenectomy and Prognosis in Patients With Pancreatic Ductal Adenocarcinoma</title><author>Liu, Li ; Katz, Matthew H ; Lee, Sun M ; Fischer, Laurice K ; Prakash, Laura ; Parker, Nathan ; Wang, Hua ; Varadhachary, Gauri R ; Wolff, Robert A ; Lee, Jeffrey E ; Pisters, Peter W ; Maitra, Anirban ; Fleming, Jason B ; Estrella, Jeannelyn ; Rashid, Asif ; Wang, Huamin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3561-511854e7198d84c6f479e6195896fe9a088688ed2f679fd53ebae9fdb0b04cc13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biopsy</topic><topic>Carcinoma, Pancreatic Ductal - mortality</topic><topic>Carcinoma, Pancreatic Ductal - secondary</topic><topic>Carcinoma, Pancreatic Ductal - surgery</topic><topic>Chi-Square Distribution</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Mesenteric Artery, Superior - pathology</topic><topic>Mesenteric Artery, Superior - surgery</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Recurrence, Local</topic><topic>Neoplasm Staging</topic><topic>Neoplasm, Residual</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Pancreaticoduodenectomy - mortality</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Tumor Burden</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Li</creatorcontrib><creatorcontrib>Katz, Matthew H</creatorcontrib><creatorcontrib>Lee, Sun M</creatorcontrib><creatorcontrib>Fischer, Laurice K</creatorcontrib><creatorcontrib>Prakash, Laura</creatorcontrib><creatorcontrib>Parker, Nathan</creatorcontrib><creatorcontrib>Wang, Hua</creatorcontrib><creatorcontrib>Varadhachary, Gauri R</creatorcontrib><creatorcontrib>Wolff, Robert A</creatorcontrib><creatorcontrib>Lee, Jeffrey E</creatorcontrib><creatorcontrib>Pisters, Peter W</creatorcontrib><creatorcontrib>Maitra, Anirban</creatorcontrib><creatorcontrib>Fleming, Jason B</creatorcontrib><creatorcontrib>Estrella, Jeannelyn</creatorcontrib><creatorcontrib>Rashid, Asif</creatorcontrib><creatorcontrib>Wang, Huamin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgical pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Li</au><au>Katz, Matthew H</au><au>Lee, Sun M</au><au>Fischer, Laurice K</au><au>Prakash, Laura</au><au>Parker, Nathan</au><au>Wang, Hua</au><au>Varadhachary, Gauri R</au><au>Wolff, Robert A</au><au>Lee, Jeffrey E</au><au>Pisters, Peter W</au><au>Maitra, Anirban</au><au>Fleming, Jason B</au><au>Estrella, Jeannelyn</au><au>Rashid, Asif</au><au>Wang, Huamin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Superior Mesenteric Artery Margin of Posttherapy Pancreaticoduodenectomy and Prognosis in Patients With Pancreatic Ductal Adenocarcinoma</atitle><jtitle>The American journal of surgical pathology</jtitle><addtitle>Am J Surg Pathol</addtitle><date>2015-10</date><risdate>2015</risdate><volume>39</volume><issue>10</issue><spage>1395</spage><epage>1403</epage><pages>1395-1403</pages><issn>0147-5185</issn><eissn>1532-0979</eissn><abstract>Negative-margin resection is crucial to favorable prognosis in patients with pancreatic ductal adenocarcinoma. However, the definition of a negative superior mesenteric artery margin (SMAM) varies. The College of American Pathologists defines positive SMAM as the presence of tumor cells at the margin, whereas the European protocol is based on a 1 mm clearance. In this study, we examined the prognostic significance of the SMAM distance in 411 consecutive pancreatic ductal adenocarcinoma patients who completed neoadjuvant therapy and pancreaticoduodenectomy. Per College of American Pathologists criteria, 32 (7.8%) had positive margins, and 379 (92.2%) had negative margins. Among margin-negative group, SMAM was ≤1, 1.0 to 5.0, and >5.0 mm in 66, 145, and 168 patients, respectively. There was no difference in either disease-free survival (DFS) or overall survival (OS) between the positive-margin group and SMAM≤1 mm (P>0.05). However, patients with SMAM 1.0 to 5.0 mm had better OS than those with positive margins or SMAM≤1 mm (P=0.02). Patients with SMAM>5.0 mm had better DFS and OS than those with SMAM 1.0 to 5.0 mm and those with positive margins or SMAM≤1 mm (P<0.01). By multivariate analysis, the SMAM distance, tumor differentiation, lymph node metastasis, and histopathologic tumor response grade were independent prognostic factors for both DFS and OS. SMAM distance correlated with lower ypT and AJCC stages, smaller tumor size, better histopathologic tumor response grade, fewer lymph node metastases, and recurrences (P<0.05). Thus our results strongly support use of SMAM>1 mm for R0 resection in posttherapy pancreaticoduodenectomy specimens.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>26200098</pmid><doi>10.1097/PAS.0000000000000491</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biopsy Carcinoma, Pancreatic Ductal - mortality Carcinoma, Pancreatic Ductal - secondary Carcinoma, Pancreatic Ductal - surgery Chi-Square Distribution Disease-Free Survival Female Humans Kaplan-Meier Estimate Lymphatic Metastasis Male Mesenteric Artery, Superior - pathology Mesenteric Artery, Superior - surgery Middle Aged Multivariate Analysis Neoadjuvant Therapy Neoplasm Recurrence, Local Neoplasm Staging Neoplasm, Residual Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy - adverse effects Pancreaticoduodenectomy - methods Pancreaticoduodenectomy - mortality Predictive Value of Tests Proportional Hazards Models Retrospective Studies Risk Factors Time Factors Treatment Outcome Tumor Burden |
| title | Superior Mesenteric Artery Margin of Posttherapy Pancreaticoduodenectomy and Prognosis in Patients With Pancreatic Ductal Adenocarcinoma |
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