Anatomically resectable versus biologically borderline resectable pancreatic cancer definition: refining the border beyond anatomical criteria and biological aggressiveness.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2025-05-07 DOI:10.1093/bjsopen/zraf033
Giulio Belfiori, Federico De Stefano, Domenico Tamburrino, Giulia Gasparini, Francesca Aleotti, Paolo R Camisa, Claudia Arcangeli, Marco Schiavo Lena, Nicolo Pecorelli, Diego Palumbo, Stefano Partelli, Francesco De Cobelli, Michele Reni, Stefano Crippa, Massimo Falconi
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引用次数: 0

Abstract

Background: The anatomically resectable pancreatic ductal adenocarcinoma treatment sequence is still debated. Heterogeneity in patient characteristics within this group may explain literature discrepancies. To overcome these limits, a biologically borderline resectable pancreatic ductal adenocarcinoma category has been analysed according to institutional criteria. The aim of this study was to examine the characteristics and outcomes of patients with biologically borderline resectable pancreatic ductal adenocarcinoma and determine whether they represent a distinct clinical and prognostic subgroup.

Methods: Data from all consecutive patients who underwent surgical resection for pancreatic ductal adenocarcinoma between 2015 and 2022 were retrospectively analysed. Biologically borderline resectable disease was classified by the presence of one or more of the following: carbohydrate antigen 19-9 ≥200 U/ml, cancer-related symptoms lasting >40 days, and radiological suspicion of regional lymph node metastases at diagnosis.

Results: In total, 886 patients were included in the study and divided into anatomically borderline resectable (266 patients (30%)) and anatomically resectable (620 patients (70%)), which was further divided into resectable (R; 397 patients (64%)) and biologically borderline resectable (223 patients (36%)). Neoadjuvant treatment was administered in 245 patients (92.1%) in the anatomically borderline resectable group, 82 patients (20.7%) in the R group, and 135 patients (60.5%) in the biologically borderline resectable group. After a median follow-up of 45 (95% c.i. 42 to 48) months, the median disease-specific survival in the biologically borderline resectable group was 40 months compared with 59 months in the R group (P < 0.001) and 40 months in the anatomically borderline resectable group (P = 0.570). In the upfront surgery cohort, the median disease-specific survival was worse for biologically borderline resectable patients compared with R patients (27 versus 54 months respectively, P < 0.001). Biologically borderline resectable was also independently associated with worse disease-specific survival, together with age, tumour size at diagnosis, and anatomically borderline resectable. The same, except for age, were also predictors of worse event-free survival.

Conclusion: Despite their identical anatomical appearance, resectable and biologically borderline resectable pancreatic ductal adenocarcinoma represent two distinct prognostic entities, warranting separate evaluation and, potentially, different treatment approaches.

解剖学上可切除与生物学上可切除胰腺癌的定义:细化解剖标准和生物学侵袭性之外的边界。
背景:解剖可切除胰导管腺癌的治疗顺序仍有争议。该组患者特征的异质性可以解释文献差异。为了克服这些限制,根据制度标准分析了生物学上边缘性可切除的胰腺导管腺癌类别。本研究的目的是检查生物学临界可切除胰腺导管腺癌患者的特征和结果,并确定他们是否代表一个独特的临床和预后亚组。方法:回顾性分析2015年至2022年间连续接受胰管腺癌手术切除的所有患者的数据。生物学上边缘性可切除的疾病通过以下一种或多种存在来分类:碳水化合物抗原19-9≥200 U/ml,癌症相关症状持续bb0 - 40天,诊断时放射学怀疑区域淋巴结转移。结果:共纳入886例患者,分为解剖边缘可切除(266例,占30%)和解剖可切除(620例,占70%),解剖可切除组进一步分为可切除组(R;397例(64%))和生物学边缘可切除(223例(36%))。解剖边缘可切除组245例(92.1%),R组82例(20.7%),生物学边缘可切除组135例(60.5%)接受新辅助治疗。中位随访45个月(95% ci = 42 ~ 48)后,生物边缘可切除组的中位疾病特异性生存期为40个月,而R组为59个月(P < 0.001),解剖边缘可切除组为40个月(P = 0.570)。在前期手术队列中,生物学边缘可切除患者的中位疾病特异性生存期比R患者更差(分别为27个月和54个月,P < 0.001)。生物边缘可切除性也与较差的疾病特异性生存率、年龄、诊断时肿瘤大小和解剖边缘可切除性独立相关。除了年龄之外,其他因素也预示着无事件生存期的恶化。结论:尽管解剖外观相同,可切除的和生物学上边缘性可切除的胰腺导管腺癌代表两种不同的预后实体,需要单独评估,并可能采用不同的治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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