Systematic Analysis of Accuracy in Predicting Complete Oncological Resection in Pancreatic Cancer Patients—Proposal of a New Simplified Borderline Resectability Definition

Background: Borderline resectability in pancreatic cancer (PDAC) is currently debated. Methods: Patients undergoing pancreatic resections for PDAC were identified from a prospectively maintained database. As new borderline criteria, the presence of any superior mesenterico-portal vein alteration (SMPV) and perivascular stranding of the superior mesenteric artery (SMA) was evaluated in preoperative imaging. The accuracy of established radiological borderline criteria as compared to the new borderline criteria in predicting R status (sensitivity/negative predictive value) and overall survival was assessed. Results: 118 patients undergoing pancreatic resections for PDAC from 2013 to 2018 were identified. Forty-three (36.4%) had radiological perivascular SMA stranding and 55 (46.6%) had SMPV alterations. Interrater reliability was 90% for SMA stranding and 87% for SMPV alterations. The new borderline definition including SMPV alterations and perivascular SMA stranding was the best predictor of conventional R status (p = 0.040, sensitivity 53%, negative predictive value 81%) and Leeds/Wittekind circumferential margin status (p = 0.050, sensitivity 73%, negative predictive value 79%) as compared to established borderline resectability definition criteria. Perivascular SMA stranding qualified as an independent negative prognostic parameter (HR 3.066, 95% CI 1.078–5.716, p = 0.036). Conclusion: The radiological evaluation of any SMPV alteration and perivascular SMA stranding predicts R status and overall survival in PDAC patients, and may serve to identify potential candidates for neoadjuvant therapy.

[1]  U. Tateishi,et al.  Reticular pattern around superior mesenteric artery in computed tomography imaging predicting poor prognosis of pancreatic head cancer , 2019, Journal of hepato-biliary-pancreatic sciences.

[2]  M. Büchler,et al.  Meta‐analysis of recurrence pattern after resection for pancreatic cancer , 2019, The British journal of surgery.

[3]  Eun Sun Lee,et al.  Preoperative CT Classification of the Resectability of Pancreatic Cancer: Interobserver Agreement. , 2019, Radiology.

[4]  F. Sonohara,et al.  Biological and conditional factors should be included when defining criteria for resectability for patients with pancreatic cancer. , 2019, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[5]  M. Büchler,et al.  Local radicality and survival outcome of pancreatic cancer surgery , 2019, Annals of gastroenterological surgery.

[6]  M. Falconi,et al.  Nerves and Pancreatic Cancer: New Insights into A Dangerous Relationship , 2019, Cancers.

[7]  R. Braren,et al.  Borderline-resectable pancreatic adenocarcinoma: Contour irregularity of the venous confluence in pre-operative computed tomography predicts histopathological infiltration , 2019, PloS one.

[8]  J. Windsor,et al.  International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. , 2017, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.].

[9]  L. Schwartz,et al.  Alliance for clinical trials in oncology (ALLIANCE) trial A021501: preoperative extended chemotherapy vs. chemotherapy plus hypofractionated radiation therapy for borderline resectable adenocarcinoma of the head of the pancreas , 2017, BMC Cancer.

[10]  E. Vasile,et al.  Multimodal treatment of resectable pancreatic ductal adenocarcinoma. , 2017, Critical reviews in oncology/hematology.

[11]  Kyubo Kim,et al.  Impact of Resection Margin Distance on Survival of Pancreatic Cancer: A Systematic Review and Meta-Analysis , 2016, Cancer research and treatment : official journal of Korean Cancer Association.

[12]  L. Schwartz,et al.  Preoperative Modified FOLFIRINOX Treatment Followed by Capecitabine-Based Chemoradiation for Borderline Resectable Pancreatic Cancer: Alliance for Clinical Trials in Oncology Trial A021101. , 2016, JAMA surgery.

[13]  J. Long,et al.  New insights into perineural invasion of pancreatic cancer: More than pain. , 2016, Biochimica et biophysica acta.

[14]  V. Longo,et al.  Neoadjuvant multimodal treatment of pancreatic ductal adenocarcinoma. , 2016, Critical reviews in oncology/hematology.

[15]  H. Yamaue,et al.  Pancreatic neck cancer has specific and oncologic characteristics regarding portal vein invasion and lymph node metastasis. , 2016, Surgery.

[16]  M. Langer,et al.  Mesopancreatic Stromal Clearance Defines Curative Resection of Pancreatic Head Cancer and Can Be Predicted Preoperatively by Radiologic Parameters , 2016, Medicine.

[17]  J. Kench,et al.  Meta‐analysis of radical resection rates and margin assessment in pancreatic cancer , 2015, The British journal of surgery.

[18]  David Moher,et al.  STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies , 2015, BMJ : British Medical Journal.

[19]  J. H. Lee,et al.  The Role of Neoadjuvant Chemoradiation Therapy in Patients With Borderline Resectable Pancreatic Cancer With Isolated Venous Vascular Involvement , 2015, Medicine.

[20]  D. Gouma,et al.  Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). , 2014, Surgery.

[21]  F. Tas,et al.  Performance status of patients is the major prognostic factor at all stages of pancreatic cancer , 2013, International Journal of Clinical Oncology.

[22]  A. Krasinskas,et al.  Outcomes with FOLFIRINOX for borderline resectable and locally unresectable pancreatic cancer , 2013, Journal of surgical oncology.

[23]  J. Werner,et al.  CA19-9 in Potentially Resectable Pancreatic Cancer: Perspective to Adjust Surgical and Perioperative Therapy , 2013, Annals of Surgical Oncology.

[24]  R. Pietrobon,et al.  Concomitant vascular reconstruction during pancreatectomy for malignant disease: a propensity score-adjusted, population-based trend analysis involving 10,206 patients. , 2013, JAMA surgery.

[25]  J. Berlin,et al.  Borderline Resectable Pancreatic Cancer: Need for Standardization and Methods for Optimal Clinical Trial Design , 2013, Annals of Surgical Oncology.

[26]  Jeffrey E. Lee,et al.  Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators , 2012, Cancer.

[27]  T. Keck,et al.  Locally Advanced Pancreatic Head Cancer: Margin-Positive Resection or Bypass? , 2012, ISRN surgery.

[28]  Yujian Liu,et al.  Pancreatectomy Combined with Superior Mesenteric Vein–Portal Vein Resection for Pancreatic Cancer: A Meta-analysis , 2012, World Journal of Surgery.

[29]  M. Falconi,et al.  Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy. , 2012, American journal of surgery.

[30]  S. Yamada,et al.  Correlation Between Radiographic Classification and Pathological Grade of Portal Vein Wall Invasion in Pancreatic Head Cancer , 2012, Annals of surgery.

[31]  M. Koch,et al.  Arterial Resection During Pancreatectomy for Pancreatic Cancer: A Systematic Review and Meta-Analysis , 2011, Annals of surgery.

[32]  C. Compton,et al.  The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM , 2010, Annals of Surgical Oncology.

[33]  M. Farnell,et al.  Predictive and Prognostic Value of CA 19-9 in Resected Pancreatic Adenocarcinoma , 2009, Journal of Gastrointestinal Surgery.

[34]  C. Compton,et al.  A uniform residual tumor (R) classification , 2009, Cancer.

[35]  C. Verbeke,et al.  Impact of margin status on survival following pancreatoduodenectomy for cancer: the Leeds Pathology Protocol (LEEPP). , 2009, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[36]  Jeffrey E. Lee,et al.  Impact of Resection Status on Pattern of Failure and Survival After Pancreaticoduodenectomy for Pancreatic Adenocarcinoma , 2007, Annals of surgery.

[37]  D. Finkelstein,et al.  Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[38]  K. Zhou,et al.  Pancreatic Adenocarcinoma: The Different CT Criteria for Peripancreatic Major Arterial and Venous Invasion , 2005, Journal of computer assisted tomography.

[39]  Y. Yamashita,et al.  Vascular Encasement by Pancreatic Cancer: Correlation of CT Findings with Surgical and Pathologic Results , 2001, Journal of computer assisted tomography.

[40]  K. Lillemoe,et al.  Pancreatic cancer: State‐of‐the‐art care , 2000, CA: a cancer journal for clinicians.

[41]  Broders Ac.  Malignant neoplasia of normally situated and heterotopic lymphoid tissue and its numerical microscopic grading. , 1953 .

[42]  K. Takaori.  "International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017": Will this pull us up out of the quagmire of confusing definitions and criteria? , 2018, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.].

[43]  H. Friess,et al.  [S3-guideline exocrine pancreatic cancer]. , 2013, Zeitschrift fur Gastroenterologie.

[44]  T. Takada,et al.  Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. , 2008, Archives of surgery.

[45]  A. C. Broders.  Malignant neoplasia of normally situated and heterotopic lymphoid tissue and its numerical microscopic grading. , 1953, Texas state journal of medicine.