Impact of Resection Margin Status in Patients with Pancreatic Cancer: a National Cohort Study

Abstract

Aim

To assess the predictors and influence of resection margins and the role of neoadjuvant and adjuvant therapy on survival for a national cohort of patients with resected pancreatic cancer.

Methods

Using the National Cancer Data Base between 2004 and 2016, 56,532 patients were identified who underwent surgical resection for pancreatic adenocarcinoma. Univariate and multivariate models were employed to identify factors predicting R0/R1 resection and assess the impact on survival.

Results

In total, 48,367 (85.6%) patients were found to have negative margins (R0) compared to 8165 (14.4%) who had microscopic residual tumor (R1). Factors predicting positive margin on univariate analysis included male gender, Medicare, advanced stage, moderately or poorly differentiated tumor, lymphovascular invasion, and tumors > 2 cm. Factors predicting R0 resection included receipt of neoadjuvant therapy and treatment at an Academic/Research Center. Following adjustment for other factors, margin status remained an independent predictor for overall survival (HR: 1.24; 95% CI 1.22–1.27, p < 0.001) (1-, 3-, and 5-year overall survival rates (R0: 77%, 37%, and 25% vs R1: 62%, 19%, and 10%).

Conclusions

A positive margin predicts a poorer survival than R0 resections regardless of stage and receipt of adjuvant therapy. Several modifiable factors significantly predict the likelihood of R0 resection including neoadjuvant treatment and treatment at Academic/Research Programs. Knowledge about these factors can help guide patient management by offering neoadjuvant treatment modalities at Academic as well as Community hospitals.

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Author information

Affiliations

Authors

Contributions

Christof Kaltenmeier: data gathering, analysis, manuscript writing

Ibrahim Nassour: data gathering, manuscript editing

Richard S Hoehn: manuscript editing

Sidrah Khan: data gathering

Alison Althans: data gathering, manuscript editing

David A Geller: manuscript editing

Alessandro Paniccia: writing manuscript, editing

Amer Zureikat: editing manuscript

Samer Tohme: data gathering, analysis, writing manuscript

Corresponding author

Correspondence to Samer Tohme.

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Conflict of interest statement

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The University of Pittsburgh holds a Physician-Scientist Institutional Award from the Burroughs Wellcome Fund: C.K. S.K.

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Kaltenmeier, C., Nassour, I., Hoehn, R.S. et al. Impact of Resection Margin Status in Patients with Pancreatic Cancer: a National Cohort Study. J Gastrointest Surg (2020). https://doi.org/10.1007/s11605-020-04870-6

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Keywords

  • Margin status
  • survival
  • predictors of R1 resection
  • pancreatic cancer