The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma

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Fältnamn	Indikatorer	Metadata
000		07453naa a2200709 4500
001		oai:DiVA.org:uu-383878
003		SwePub
008		190611s2019 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3838782 URI
024	7	a https://doi.org/10.1097/SLA.00000000000025572 DOI
040		a (SwePub)uu
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Ghaneh, Paulau Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England;Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England4 aut
245	1 0	a The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma
264	1	c 2019
338		a print2 rdacarrier
520		a Objective and Background: Local and distant disease recurrence are frequently observed following pancreatic cancer resection, but an improved understanding of resection margin assessment is required to aid tailored therapiesMethods: Analyses were carried out to assess the association between clinical characteristics and margin involvement as well as the effects of individual margin involvement on site of recurrence and overall and recurrence-free survival using individual patient data from the European Study Group for Pancreatic Cancer (ESPAC)-3 randomized controlled trial.Results: There were 1151 patients, of whom 505 (43.9%) had an RI resection. The median and 95% confidence interval (CI) overall survival was 24.9 (22.9-27.2) months for 646 (56.1%) patients with resection margin negative R0 >1 mm) tumors, 25.4 (21.6 30.4) months for 146 (12.7%) patients with RI <1 mm positive resection margins, and 18.7 (17.2-21.1) months for 359 (31.2%) patients with R1-direct positive margins (P < 0.001). In multivariable analysis, overall R 1-direct tumor margins, poor tumor differentiation, positive lymph node status, WHO performance status ≥ 1, maximum tumor size, and RI-direct posterior resection margin were all independently significantly associated with reduced overall and recurrence-free survival. Competing risks analysis showed that overall R1-direct positive resection margin status, positive lymph node status. WHO performance status 1, and R1-direct positive superior mesenteric/medial margin resection status were all significantly associated with local recurrence.Conclusions: RI-direct resections were associated with significantly reduced overall and recurrence-free survival following pancreatic cancer resection. Resection margin involvement was also associated with an increased risk for local recurrence.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
653		a pancreatic cancer
653		a recurrence
653		a resection margins
653		a surgery
653		a survival
700	1	a Kleeff, Jorgu Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England;Martin Luther Univ Halle Wittenberg, Univ Hosp Halle, Dept Surg, Halle, Germany4 aut
700	1	a Halloran, Christopher M.u Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England4 aut
700	1	a Raraty, Michaelu Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England4 aut
700	1	a Jackson, Richardu Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England4 aut
700	1	a Melling, Jamesu Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England4 aut
700	1	a Jones, Owainu Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England4 aut
700	1	a Palmer, Daniel H.u Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England4 aut
700	1	a Cox, Trevor F.u Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England4 aut
700	1	a Smith, Chloe J.u Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England4 aut
700	1	a O'Reilly, Derek A.u Manchester Royal Infirm, Dept Surg, Manchester, Lancs, England4 aut
700	1	a Izbicki, Jakob R.u Univ Hamburg, Dept Surg, Med Inst UKE, Hamburg, Germany4 aut
700	1	a Scarfe, Andrew G.u Univ Alberta, Dept Oncol, Div Med Oncol, Cross Canc Inst 2228, Edmonton, AB, Canada4 aut
700	1	a Valle, Juan W.u The Christie, Dept Med Oncol, Manchester, Lancs, England4 aut
700	1	a McDonald, Alexander C.u Beatson West Scotland Canc Ctr, Dept Med Oncol, Glasgow, Lanark, Scotland4 aut
700	1	a Carter, Rossu Glasgow Royal Infirm, Dept Surg, Glasgow, Lanark, Scotland4 aut
700	1	a Tebbutt, Niall C.u Austin Hlth, Dept Med Oncol, Melbourne, Vic, Australia4 aut
700	1	a Goldstein, Davidu Univ New South Wales, Prince Wales Hosp, Dept Med Oncol, Sydney, NSW, Australia;Univ New South Wales, Sch Clin, Sydney, NSW, Australia4 aut
700	1	a Padbury, Robertu Flinders Med Ctr, Dept Surg, Adelaide, SA, Australia4 aut
700	1	a Shannon, Jenniferu Nepean Canc Ctr, Dept Med Oncol, Nepean, ON, Australia;Univ Sydney, Sydney, NSW, Australia4 aut
700	1	a Dervenis, Christosu Agia Olga Hosp, Dept Surg, Athens, Greece4 aut
700	1	a Glimelius, Bengtu Uppsala universitet,Experimentell och klinisk onkologi4 aut0 (Swepub:uu)bengglim
700	1	a Deakin, Marku Univ Hosp North Staffordshire, Dept Surg, Stoke On Trent, Staffs, England4 aut
700	1	a Anthoney, Alanu Univ Leeds, St Jamess Univ Hosp, Div Oncol, Leeds, W Yorkshire, England4 aut
700	1	a Lerch, Markus M.u Univ Med Greifswald, Dept Med A, Greifswald, Germany4 aut
700	1	a Mayerle, Juliau Univ Med Greifswald, Dept Med A, Greifswald, Germany4 aut
700	1	a Olah, Attilau Petz Aladar Hosp, Dept Surg, Gyor, Hungary4 aut
700	1	a Rawcliffe, Charlotte L.u Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England4 aut
700	1	a Campbell, Fionau Heidelberg Univ, Dept Surg, Heidelberg, Germany4 aut
700	1	a Strobel, Oliveru Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Pathol, Liverpool, Merseyside, England4 aut
700	1	a Buechler, Markus W.u Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Pathol, Liverpool, Merseyside, England4 aut
700	1	a Neoptolemos, John P.u Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England;Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England;Heidelberg Univ, Dept Surg, Heidelberg, Germany4 aut
710	2	a Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England;Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, Englandb Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England;Martin Luther Univ Halle Wittenberg, Univ Hosp Halle, Dept Surg, Halle, Germany4 org
773	0	t Annals of Surgeryg 269:3, s. 520-529q 269:3<520-529x 0003-4932x 1528-1140
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-383878
856	4 8	u https://doi.org/10.1097/SLA.0000000000002557

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