Limits...
Mesopancreatic Stromal Clearance Defines Curative Resection of Pancreatic Head Cancer and Can Be Predicted Preoperatively by Radiologic Parameters

View Article: PubMed Central - PubMed

ABSTRACT

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a strong fibrotic stromal reaction and diffuse growth pattern. Peritumoral fibrosis is often evident during surgery but only distinguishable from tumor by microscopic examination. The aim of this study was to investigate the role of clearance of fibrotic stromal reaction at the mesopancreatic resection margin as a criterion for radical resection and preoperative assessment of resectability.

Mesopancreatic stromal clearance status (S-status) was defined as the presence or absence (S+/S0) of fibrotic stromal reaction at the mesopancreatic resection margin. Detailed retrospective clinicopathologic re-evaluation of margin status and preoperative cross-sectional imaging was performed in a cohort of 91 patients operated for pancreatic head PDAC from 2001 to 2011.

Conventional margin positive resection (R+, tumor cells directly at the margin) was found in 36%. However, S-status further divided the margin negative (R0) group into patients with median survival of 14 months versus 31 months (S+ versus S0, P = 0.005). Overall rate of S+ was 53%. S-status and lymph node ratio constituted the only independent predictors of survival. Stranding of the superior mesenteric artery fat sheath was the only independent radiologic predictor of S+ resection, and achieved a 71% correct prediction of S-status.

Mesopancreatic stromal clearance is a major determinant of curative resection in PDAC, and preoperative prediction by cross-sectional imaging is possible, setting the basis for a new definition of borderline resectability.

No MeSH data available.


Related in: MedlinePlus

Survival analysis. A–D, Kaplan–Meier plots for comparison of survival after resection of pancreatic head cancer for (A) conventional R0 versus R+ resection, (B) mesopancreatic stroma negative (S0) versus stroma positive (S+) resection, (C) high versus low lymph node ratio (LNR), and (D) patients with S0 margins and low LNR versus patients with S+ margins and high lymph node ratio versus the rest. See also Table 2 for details. E, F, Kaplan–Meier plots for comparison of survival after R0 resection of pancreatic head cancer for (E) mesopancreatic stroma negative (S0) versus stroma positive (S+) resection and (F) patients with S0 resection and no lymph node metastasis (N0) versus S0 resection with lymph node metastasis versus S+ resection. See also Table 3 for details. LNR = lymph node ratio; N0/N+ = locoregional node metastasis absent/present; R-status = conventional resection margin status; R0/R+ = conventional margin negative/positive; S-status = mesopancreatic stromal clearance status; S0/S+ = mesopancreatic margin negative/positive for fibrotic stromal reaction, P values given for 2-sided Logrank test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998270&req=5

Figure 3: Survival analysis. A–D, Kaplan–Meier plots for comparison of survival after resection of pancreatic head cancer for (A) conventional R0 versus R+ resection, (B) mesopancreatic stroma negative (S0) versus stroma positive (S+) resection, (C) high versus low lymph node ratio (LNR), and (D) patients with S0 margins and low LNR versus patients with S+ margins and high lymph node ratio versus the rest. See also Table 2 for details. E, F, Kaplan–Meier plots for comparison of survival after R0 resection of pancreatic head cancer for (E) mesopancreatic stroma negative (S0) versus stroma positive (S+) resection and (F) patients with S0 resection and no lymph node metastasis (N0) versus S0 resection with lymph node metastasis versus S+ resection. See also Table 3 for details. LNR = lymph node ratio; N0/N+ = locoregional node metastasis absent/present; R-status = conventional resection margin status; R0/R+ = conventional margin negative/positive; S-status = mesopancreatic stromal clearance status; S0/S+ = mesopancreatic margin negative/positive for fibrotic stromal reaction, P values given for 2-sided Logrank test.

Mentions: To further evaluate the prognostic role of the S-status, a subgroup analysis in patients with conventional margin negative resection (R0) was performed (Table 3 and Figure 3). Similarly to the results outlined above, the S-status discriminated sharply between patients with favorable and poor survival (S+ vs S0, median survival 14 vs 31 months, P = 0.005) in this smaller (n = 58) subgroup with a median overall survival of 27 months. Locoregional lymph node metastasis (N0/N+) further subdivided the prognostic categories: Survival after S0 resection with positive locoregional lymph nodes was 29 months, while median survival was not even reached during follow-up in the small group of patients with S0 resection and negative lymph nodes (n = 14, P = 0.01) (Table 3 and Figure 3).


Mesopancreatic Stromal Clearance Defines Curative Resection of Pancreatic Head Cancer and Can Be Predicted Preoperatively by Radiologic Parameters
Survival analysis. A–D, Kaplan–Meier plots for comparison of survival after resection of pancreatic head cancer for (A) conventional R0 versus R+ resection, (B) mesopancreatic stroma negative (S0) versus stroma positive (S+) resection, (C) high versus low lymph node ratio (LNR), and (D) patients with S0 margins and low LNR versus patients with S+ margins and high lymph node ratio versus the rest. See also Table 2 for details. E, F, Kaplan–Meier plots for comparison of survival after R0 resection of pancreatic head cancer for (E) mesopancreatic stroma negative (S0) versus stroma positive (S+) resection and (F) patients with S0 resection and no lymph node metastasis (N0) versus S0 resection with lymph node metastasis versus S+ resection. See also Table 3 for details. LNR = lymph node ratio; N0/N+ = locoregional node metastasis absent/present; R-status = conventional resection margin status; R0/R+ = conventional margin negative/positive; S-status = mesopancreatic stromal clearance status; S0/S+ = mesopancreatic margin negative/positive for fibrotic stromal reaction, P values given for 2-sided Logrank test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998270&req=5

Figure 3: Survival analysis. A–D, Kaplan–Meier plots for comparison of survival after resection of pancreatic head cancer for (A) conventional R0 versus R+ resection, (B) mesopancreatic stroma negative (S0) versus stroma positive (S+) resection, (C) high versus low lymph node ratio (LNR), and (D) patients with S0 margins and low LNR versus patients with S+ margins and high lymph node ratio versus the rest. See also Table 2 for details. E, F, Kaplan–Meier plots for comparison of survival after R0 resection of pancreatic head cancer for (E) mesopancreatic stroma negative (S0) versus stroma positive (S+) resection and (F) patients with S0 resection and no lymph node metastasis (N0) versus S0 resection with lymph node metastasis versus S+ resection. See also Table 3 for details. LNR = lymph node ratio; N0/N+ = locoregional node metastasis absent/present; R-status = conventional resection margin status; R0/R+ = conventional margin negative/positive; S-status = mesopancreatic stromal clearance status; S0/S+ = mesopancreatic margin negative/positive for fibrotic stromal reaction, P values given for 2-sided Logrank test.
Mentions: To further evaluate the prognostic role of the S-status, a subgroup analysis in patients with conventional margin negative resection (R0) was performed (Table 3 and Figure 3). Similarly to the results outlined above, the S-status discriminated sharply between patients with favorable and poor survival (S+ vs S0, median survival 14 vs 31 months, P = 0.005) in this smaller (n = 58) subgroup with a median overall survival of 27 months. Locoregional lymph node metastasis (N0/N+) further subdivided the prognostic categories: Survival after S0 resection with positive locoregional lymph nodes was 29 months, while median survival was not even reached during follow-up in the small group of patients with S0 resection and negative lymph nodes (n = 14, P = 0.01) (Table 3 and Figure 3).

View Article: PubMed Central - PubMed

ABSTRACT

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a strong fibrotic stromal reaction and diffuse growth pattern. Peritumoral fibrosis is often evident during surgery but only distinguishable from tumor by microscopic examination. The aim of this study was to investigate the role of clearance of fibrotic stromal reaction at the mesopancreatic resection margin as a criterion for radical resection and preoperative assessment of resectability.

Mesopancreatic stromal clearance status (S-status) was defined as the presence or absence (S+/S0) of fibrotic stromal reaction at the mesopancreatic resection margin. Detailed retrospective clinicopathologic re-evaluation of margin status and preoperative cross-sectional imaging was performed in a cohort of 91 patients operated for pancreatic head PDAC from 2001 to 2011.

Conventional margin positive resection (R+, tumor cells directly at the margin) was found in 36%. However, S-status further divided the margin negative (R0) group into patients with median survival of 14 months versus 31 months (S+ versus S0, P = 0.005). Overall rate of S+ was 53%. S-status and lymph node ratio constituted the only independent predictors of survival. Stranding of the superior mesenteric artery fat sheath was the only independent radiologic predictor of S+ resection, and achieved a 71% correct prediction of S-status.

Mesopancreatic stromal clearance is a major determinant of curative resection in PDAC, and preoperative prediction by cross-sectional imaging is possible, setting the basis for a new definition of borderline resectability.

No MeSH data available.


Related in: MedlinePlus