The impact of intraoperative pancreatic resection margin status on prognosis of patients with pancreatic head cancer

Q4 Medicine

中华肝胆外科杂志 Pub Date : 2019-11-28 DOI:10.3760/CMA.J.ISSN.1007-8118.2019.11.013

Yang-Ke Hu, Shengdong Wu, Ke Wang, Jing Huang, Jiongze Fang, Caide Lu

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引用次数: 0

Abstract

Objective To study the impact of intraoperative pancreatic resection margin status on prognosis in patients with pancreatic head cancer. Methods The clinical and follow-up data of 109 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili Hospital from March 2012 to October 2018 were analyzed retrospectively. The association of intraoperative resection margin status and other clinicopathological factors on prognosis was analyzed by the Kaplan-Meier method and the Cox proportional hazard model. Logistic multivariate analysis was used to study factors influencing the margin status. Results Of 109 patients, 20 had a positive intraoperative resection margin, and 89 had a negative margin. Postoperative pathological examination showed that all the patients had a negative surgical margin. Univariate analysis suggested that CA19-9 before operation, preoperative adjuvant chemotherapy, intraoperative pancreatic resection margin status, maximum diameter of tumor, perineural invasion, lymphovascular invasion, tumor differentiation, and N staging were significantly related to survival in the entire cohort (all P 0.05). Analysis of the clinicopathological factors between the two groups showed that in the positive pancreatic neck margin group, the distribution of adverse pathologic factors like low tumor differentiation, tumor diameter ≥4 cm, perineural invasion and lymphovascular invasion were significantly different compared with the negative group (P<0.05). Tumor diameter ≥4 cm (OR=5.72, 95%CI: 1.60~20.49) and low tumor differentiation (OR=3.79, 95%CI: 1.20~11.95) were independent influencing factors of positive margin on logistic multivariate analysis. Conclusions Intraoperative pancreatic positive margin was not an independent risk factor of prognosis, but it was meaningful in predicting survival. Presence of positive margins was often combined with existence of some adverse pathological features, such as large tumor diameter and low tumor differentiation. Prognosis of patients with a positive margin was often poor. A positive pancreatic margin was an intraoperative marker of poor tumor biology in patients with pancreatic ductal adenocarcinoma. Key words: Pancreatic neoplasms; Positive margin; Pancreaticoduodenectomy; Prognosis

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术中胰腺切除术切缘状态对癌症患者预后的影响

目的探讨癌症胰头癌术中切缘状态对预后的影响。方法回顾性分析2012年3月至2018年10月在宁波市李惠利医院行胰十二指肠切除术的109例患者的临床和随访数据。采用Kaplan-Meier方法和Cox比例风险模型分析术中切除边缘状态和其他临床病理因素对预后的影响。采用Logistic多变量分析法研究影响边际状态的因素。结果109例患者中，术中切缘阳性20例，阴性89例。术后病理检查显示，所有患者的手术切缘均为阴性。单因素分析提示术前CA19-9、术前辅助化疗、术中胰腺切除切缘状态、肿瘤最大直径、神经浸润、淋巴管浸润、肿瘤分化程度、，两组临床病理因素分析显示，胰腺颈缘阳性组肿瘤分化程度低、肿瘤直径≥4cm、，肿瘤直径≥4cm（OR=5.72，95%CI:1.60~20.49）和肿瘤分化程度低（OR=3.79，95%CI:1.20～11.95）是影响多因素logistic分析阳性边缘的独立因素。结论术中胰腺阳性边缘不是一个独立的预后危险因素，但对预测生存率有意义。阳性边缘的存在通常与一些不良病理特征的存在相结合，如肿瘤直径大和肿瘤分化程度低。具有阳性边缘的患者的预后通常较差。胰腺边缘阳性是胰腺导管腺癌患者肿瘤生物学较差的术中标志。关键词：胰腺肿瘤；正裕度；胰十二指肠切除术；预后

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来源期刊

中华肝胆外科杂志 Medicine-Gastroenterology

CiteScore

0.20

自引率

0.00%

发文量

7101

期刊介绍： Chinese Journal of Hepatobiliary Surgery is an academic journal organized by the Chinese Medical Association and supervised by the China Association for Science and Technology, founded in 1995. The journal has the following columns: review, hot spotlight, academic thinking, thesis, experimental research, short thesis, case report, synthesis, etc. The journal has been recognized by Beida Journal (Chinese Journal of Humanities and Social Sciences). Chinese Journal of Hepatobiliary Surgery has been included in famous databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences), CSCD Source Journals of China Science Citation Database (with Extended Version) and so on, and it is one of the national key academic journals under the supervision of China Association for Science and Technology.